Do candidates for penile implant prefer their doctors or another implanted patient as their information source? Results of a pilot study.

INTRODUCTION: Erectile dysfunction incidence is about 19-26 cases for every 1000 men/year, requiring about 20,000 penile implants/year. There is high demand for information on the part of patients, however, there is a lack of evidence about the sources of information prior to penile implant and the figure of the Expert Patient (EP) has never been described in this area. AIMS: To evaluate the sources of information used by candidates for penile implant as well as to describe the role of the EP as an information source. METHODS: Pilot study of candidates for penile prosthesis. Patients already implanted attending for exchange or reallocation surgery were excluded. Each patient had an interview with an EP, and commercial documentation was given. Each source of information was evaluated in a face-to-face interview. SPSS™ version 20.0 was used. MAIN OUTCOME MEASURES: The EP was evaluated by the International Index of Erectile Function, the Generalized Anxiety Disorder 7 questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction. Each source of information was evaluated by a non-validated 6-section questionnaire. RESULTS: Ten patients were included. Mean age was 60±10.3 years. Medical interview with the urologist resulted in a global value and truthfulness score of 9.2±.9 and 9.8±.4, respectively. Commercial information had a global score of 8.5±.9 and a truthfulness score of 8.6±.6, while the internet had 6.8±.8 points for global value and 7.2±1 for truthfulness. The global score of the EP was 8.7±1.2 points and their veracity scored 9.6±.5 points. CONCLUSIONS: The urologist remains the main source of information for patients with erectile dysfunction candidates for penile prosthesis implant. However, the EP is an alternative and could be a key pillar in presurgical counselling.

ANalogical UroFlowmetry (ANUF): Correspondence Between This New Visual Pictogram and Uroflowmetry in Men With Lower Urinary Tract Symptoms: A new approach for the study of male micturition dynamics.

OBJECTIVE: To study the correlation between a new visual tool (ANalogical UroFlowmetry (ANUF)) and uroflowmetry (UF) parameters when performed to assess male lower urinary tract symptoms (MLUTS). METHODS: We configured an original pictogram composed of 4 different urine streams. In the setting of a University Hospital based prospective study where 545 men were enrolled between September 2018 and January 2019. Variables collected were age, UF pattern, Qmax, average flow rate (Qave), voided volume, postvoid residual, and selected image. The Spearman's rank test, ANOVA, and Tukey test, as well as the lineal regression model were used. RESULTS: A total of 358 patients fulfilled the inclusion criteria. Mean age was 64.6 ± 12 years. Mean value and standard deviationfor the Qmax were 20.4 ± 10.5 mL/s for Image1; 15.5 ± 6.4 mL/s for Image2; 13.5 ± 6.0 mL/s for Image3 and 10.4 ± 5.4 mL/s for Image4. Statistically significant negative correlations were found between ANUF and Qmax (r = -0.317; P<.0001), and ANUF and Qave (r = -0.305; P<.0001). Qmax mean values among images were statistically different when compared in pairs, except Image1 and Image2 (P= .153). The confidence intervals calculated through the lineal regression model for the Qmax and each image were Image1) 17.8, confidence interval [CI] 95%: [14.9-21.5] mL/s; Image2) 14.3, CI 95%: [13.0-15.7] mL/s; Image3) 12.3, CI 95%: [11.5-13.1] mL/s and Image4) 9.1, CI 95%: [8.1-10.3] mL/s. CONCLUSION: According to our results, ANUF is a useful and inexpensive tool presenting a correlation with the Qmax as well a correspondence of each image with a range of Qmax and its mean value.

Congenital bilateral absence of the vas deferens (CBAVD): do genetic disorders modify assisted reproductive technologies outcomes? / Ausencia congénita bilateral del conducto deferente: ¿Modifican las alteraciones genéticas los resultados de las tecnicas de reproducción asistida?

OBJECTIVES: To evaluate the impact of common Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutations, 5T polymorphism and presence of severe Cystic Fibrosis (CF) on fertility outcomes with Assisted Reproductive Techniques (ART) in patients presenting Congenital Bilateral Absence of Vas Deferens (CBAVD). METHODS: A comparative observational cohort study was performed from 2002 to 2018 with 51 patients with diagnosis of CBAVD. Presence of CFTR mutations and 5T, CF, pregnancy and newborn rates were analyzed. RESULTS: 80.4% percent had some mutation of CFTR gene being ΔF508 the most common (51%). The most frequently described genotype was the 7T/9T (31.4%) with the presence of 5T polymorphism in up to 25.5% of cases. Global newborn rates were 34% in the group using partner spermatozoa. When comparing 5T presence, we observed a decrease in newborn rates when carrying this mutation, without obtaining statistical significance (newborn rate: 5T/non-5T: 7.1/28%, p 0.45). No differences were found when comparing presence of severe CF, common CFTR gene mutations and ICSI-related parameters. CONCLUSION: The analysis of the presence of 5T polymporphism in CBAVD patients may add information when predicting the outcome of assisted reproductive techniques.

OBJETIVOS: Evaluar el impacto de las mutaciones del gen CFTR regulador de la conductancia transmembrana de la fibrosis quística, los polimorfismos 5T y la presencia de fibrosis quística (FQ) grave en los resultados de fertilidad de las técnicas de reproducción asistida en pacientes que presentan ausencia bilateral congénita de conductos deferentes.MÉTODOS: Estudio comparativo observacional de cohortes realizado desde 2002 hasta 2018 con 51 pacientes con el diagnóstico de ausencia bilateral congénita de conductos deferentes. Se analizaron la presencia de mutaciones del gen CFTR y 5T, fibrosis quística y tasas de embarazo y nacimientos. RESULTADOS: 80,4% tenían alguna mutación del CFTR siendo la ΔF508 la más frecuente (51%). El genotipo descrito con mayor frecuencia era 7T/9T (31,4%) con la presencia de polimorfismo 5T en hasta el 25,5% de los casos. Las tasas de nacimientos globales fueron del 34% en el grupo que utilizaba espermatozoides del marido. Cuando se compara la presencia de 5T, observamos una disminución en las tasas de nacimientos en los portadores de esta mutación, sin obtener significación estadística (Tasa de nacimientos 5T/no-5T: 7,1/28%, p=0,45). No se encontraron diferencias en la comparativa entre la presencia de FQ severa, mutaciones comunes del gen CFTR y los parámetros relacionados con la ICSI. CONCLUSIONES: El análisis de la presencia de polimorfismo 5T en los pacientes con ausencia bilateral congénita de conductos deferentes puede añadir información para la predicción de los resultados de las técnicas de reproducción asistida.

Congenital bilateral absence of the vas deferens (cbavd): do Genetic disorders modify assisted reproductive technologies Outcomes? / Ausencia congénita bilateral del conducto deferente: ¿Modifican las alteraciones genéticas los resultados de las tecnicas de reproducción asistida?

OBJECTIVES: To evaluate the impact of common Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutations, 5T polymorphism and presence of severe Cystic Fibrosis (CF) on fertility outcomes with Assisted Reproductive Techniques (ART) in patients presenting Congenital Bilateral Absence of Vas Deferens (CBAVD). METHODS: A comparative observational cohort study was performed from 2002 to 2018 with 51 patients with diagnosis of CBAVD. Presence of CFTR mutations and 5T, CF, pregnancy and newborn rates were analyzed. RESULTS: 80.4% percent had some mutation of CFTR gene being DeltaF508 the most common (51%). The most frequently described genotype was the 7T/9T (31.4%) with the presence of 5T polymorphism in up to 25.5% of cases. Global newborn rates were 34% in the group using partner spermatozoa. When comparing 5T presence, we observed a decrease in newborn rates when carrying this mutation, without obtaining statistical significance (newborn rate: 5T/non-5T: 7.1/28%, p 0.45). No differences were found when comparing presence of severe CF, common CFTR gene mutations and ICSI-related parameters. CONCLUSION: The analysis of the presence of 5T polymporphism in CBAVD patients may add information when predicting the outcome of assisted reproductive Techniques

OBJETIVOS: Evaluar el impacto de las mutaciones del gen CFTR regulador de la conductancia transmembrana de la fibrosis quística, los polimorfismos 5T y la presencia de fibrosis quística (FQ) grave en los resultados de fertilidad de las técnicas de reproducción asistida en pacientes que presentan ausencia bilateral congénita de conductos deferentes. MÉTODOS: Estudio comparativo observacional de cohortes realizado desde 2002 hasta 2018 con 51 pacientes con el diagnóstico de ausencia bilateral congénita de conductos deferentes. Se analizaron la presencia de mutaciones del gen CFTR y 5T, fibrosis quística y tasas de embarazo y nacimientos. RESULTADOS: 80,4% tenían alguna mutación del CFTR siendo la DeltaF508 la más frecuente (51%). El genotipo descrito con mayor frecuencia era 7T/9T (31,4%) con la presencia de polimorfismo 5T en hasta el 25,5% de los casos. Las tasas de nacimientos globales fueron del 34% en el grupo que utilizaba espermatozoides del marido. Cuando se compara la presencia de 5T, observamos una disminución en las tasas de nacimientos en los portadores de esta mutación, sin obtener significación estadística (Tasa de nacimientos 5T/no-5T: 7,1/28%, p = 0,45). No se encontraron diferencias en la comparativa entre la presencia de FQ severa, mutaciones comunes del gen CFTR y los parámetros relacionados con la ICSI. CONCLUSIONES: El análisis de la presencia de polimorfismo 5T en los pacientes con ausencia bilateral congénita de conductos deferentes puede añadir información para la predicción de los resultados de las técnicas de reproducción asistida

Principales características clínicas y de supervivencia en una serie de tumores testiculares primarios / Clinical and survival patterns among patients with primary testicular cancer

Objetivo. Realizar un análisis descriptivo en pacientes diagnosticados de cáncer testicular primario y valorar posibles factores predictores de recidiva tumoral, con el fin de establecer seguimientos individualizados. Material y métodos. Estudio longitudinal retrospectivo con una cohorte de 91 pacientes intervenidos de orquiectomía radical por tumor testicular primario entre enero del 2004 y diciembre del 2014. Las variables analizadas fueron: motivo de consulta, características ecográficas, marcadores tumorales (AFP, LDH Y β-HCG), estadio tumoral, anatomía patológica, tratamiento y presencia de recaída. Para el estudio de la recaída se han realizado una curva de Kaplan-Meier y una regresión logística para valorar factores predictores. Resultados. La edad media fue de 31,8±10,4 años. El motivo de consulta más frecuente fue masa indolora (71,1%), seguido de dolor testicular (24,4%). En la ecografía la mayoría presentaban una masa única (78,3%) y heterogénea (85,4%). El 71,4% de los casos se encontraban en estadio I, el 24,2% en estadio II y 4,4% en estadio III. En 55 pacientes se realizó únicamente orquiectomía radical, en 34 se asoció quimioterapia y en 2 se aplicó radioterapia. Durante el tiempo de seguimiento han recaído 14 pacientes (15,38%) y ha habido un fallecimiento. De las 14 recaídas, 9 ocurrieron durante el primer año. El único factor predictor de recidiva detectado fue un nivel elevado de β-HCG. Conclusión. El cáncer testicular suele diagnosticarse en un estadio localizado y tiene altas tasas de curación. Las recidivas aparecen habitualmente en los primeros años de seguimiento y el único factor predictor hallado en nuestra experiencia es una β-HCG elevada (AU)

Objective. To perform a descriptive study in patients diagnosed with testicular cancer and analyze the potential risk factors in order to establish an individualized follow up. Material and methods. We performed a longitudinal retrospective study from January 2004 to December 2014 in 91 patients with testicular cancer. They underwent to radical orchiectomy due to testicular cancer at our center. We analyzed the reason for consultation, ultrasound characteristics, tumor markers (AFP, LDH and bHGC), tumor stage, pathology, treatment and relapses during the follow up. To analyze the risk factors, we used the Kaplan Meier curve and logistic regression. Results. The mean age was 31.8±10.4. The most frequent reason for consultation was painless lump (71.1%), following by testicular pain (24.4%). The main scrotal ultrasound feature was solitary tumor (78.3%) and heterogeneous (85.4%). The stage I was present in 71.4% of the cases, 24.2% were stage II and 4.4% were stage III. Regarding the treatment, 55 patients underwent to radical orchiectomy, 34 received adjuvant chemotherapy and 2 adjuvant radiotherapy. 14 (15.38%) patients had a relapse and one patient died from testicular cancer. Nine relapses from fourteen have been during the first year after the initial treatment. We only found that a bHCG high level is a predictive factor of relapse. Conclusion. Testicular cancer is diagnosed in an early stage and it has a high cure rate. The relapse has been during the first year of follow up. In our experience, we identified bHCG high level as predictor factor (AU)

Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery.

INTRODUCTION: Penile prosthesis (PP) is the established treatment for patients with erectile dysfunction (ED) who do not respond to phosphodiesterase inhibitors and intracavernosal injections. In general, these devices have been largely successful but there are not free of serious complication such as PP infection (PPI). PPI requires immediate surgical removal or salvage rescue of the PP. AIM: In this report, we present two clinical cases with inflatable PP (IPP) treated locally with antibiotic and high pressure irrigation and then avoid the PP removal or salvage rescue. METHODS: We present two patients with PPI in our institution and literature review. MAIN OUTCOME MEASURES: Resolution of the two cases. RESULTS: Patient A (A) was 44 years old and patient B (B) 51 years old presented PPI after three weeks (A) and eight weeks (B). Both patients were diabetic. Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum were clean and dry. They had not scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). In both cases, we performed an excision of the tissue around the pump with a high pressure pulsed irrigation (Interpulse; Stryker Corp, Kalamazoo, MI, USA). For the irrigation we used three different solutions that included povidone-iodine, antibiotics (gentamicin plus vancomicin), and hydrogen peroxyde. Finally, we performed a multilayered surgical closure with the use of aspirate drainage over 24 hours and intravenous antibiotics. The patients had a total resolution of its symptoms after 20 months (A) and 36 months (B), and the IPP worked properly. CONCLUSION: This treatment could be an option for to perform specific patients with local IPP infection without systemic symptoms instead of surgical removal.

Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs.

OBJECTIVE: To evaluate the clinic characteristics, diagnosis, management, and costs of the adult acute scrotum in the emergency room (ER). Acute scrotum is a syndrome characterized by intense, acute scrotal pain that may be accompanied by other symptoms. It is usual in children and commonly found as well in adults, with different causal pathologies between these groups. METHODS: Between November 2013 and September 2014, 669 cases of adult acute scrotum who presented to our ER were prospectively analyzed. Patients under 15 years of age were excluded. Patient age, reason for consultation, investigations performed, final diagnosis, management, and costs were evaluated. For the statistical analysis, the Mann-Whitney, Kruskal-Wallis U, and chi-square tests were used. RESULTS: A total of 669 cases of acute scrotum were analyzed. The mean age at presentation was 40.2 ± 17.3 years. The most presented diagnoses were orchiepididymitis (28.7%), epididymitis (28.4%), symptoms of uncertain etiology (25.1%), and orchitis (10.3%). Diagnostic tests were carried out in 57.8% of cases. Most cases were treated as outpatients (94.2%), with 5.83% admitted and 1% undergoing surgical treatment. Overall, 13.3% of patients represented to the ER. Abnormal results in blood and urine tests were more common among older patients and infectious pathologies. The average cost generated by an acute scrotum ER consult was 195.03€. CONCLUSION: Infectious pathologies are the most common causes of acute scrotum at ER. Abnormal blood and urine tests are unusual and are more common in older patients and infectious pathologies.

[Metastatic urinary bladder involvement in breast cancer]. / AFECTACIÓN VESICAL METASTÁSICA DEL CÁNCER DE MAMA.

OBJECTIVE: To contribute to the literature with three unusual cases of primary breast tumor with metastasis to the urinary bladder. METHODS: Presentation of the three clinical cases and bibliographic review. RESULTS: Three women, with an average age of 49.3 years, were diagnosed with invasive lobular breast carcinoma. Two of them suffered from hematuria after being diagnosed with breast cancer. The third patient was diagnosed incidentally after a routine CT scan. Upon diagnosis of the bladder metastases, they already had metastasis in other locations. The treatment of the three cases was palliative. The cause of death was due to additional pathologies. CONCLUSIONS: The presence of bladder metastases due to breast cancer is infrequent. The appearance of urinary tract symptoms in these patients requires a diagnostic study in order to rule out metastases.

Long-standing hemospermia in a patient with megacava associated to a circumaortic renal vein.

Hemospermia may have a broad range of functional and organic causes. It is defined as the presence of blood in seminal fluid and usually tends to resolve spontaneously within a few weeks. We present the case of a patient with a 10-year history of hemospermia associated with megacava and circumaortic renal vein. The diagnosis, treatment, and evolution of the condition are reported. Vascular anomalies are rare causes of chronic hemospermia, and the one described in our patient may constitute the first case reported in the literature.

Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH.

OBJECTIVE: To determine the utility of prostate ultrasound in the diagnosis of infravesical obstruction (IVO) and detrusor hyperactivity(DH). METHODS: Prospective study with 39 patients consulting for LUTS. Clinical history was compiled, IPSS was determined, a digital rectal exam was performed, abdominal ultrasound was used to calculate detrusor thickness/weight, prostate volume, and middle lobe length (MLL). Urodynamic study (UD) was performed with determination of the Abrams-Griffiths number and ICS nomogram. Mean values were compared with Mann-Whitney U-test, and ROC curves were plotted determining the cutoff points for optimum sensitivity/specificity. RESULTS: Mean age was 63.1 years (SD: 7.8), with a mean IPSS score of 14 (SD: 6). 53.8% of the patients presented IVO at UD evaluation, and 43.6% DH. The differences between free flowmetry Qmax(p=0.015) and MLL (p=0.003) between patients with and without IVO proved significant. The ROC curves yielded an AUC for middle lobe length of 0.772, with a maximum sensitivity and specificity cutoff point at 10.5 mm (sensitivity 90%, specificity 73%, PPV 76%, NPV 85%). There were no significant differences in any parameter between patients with and without DH. CONCLUSION: Ultrasound MLL measurement in patients with LUTS offers high sensitivity/specificity in diagnosing IVO, with a cutoff point of 10.5 mm. In our study it wasn't effective in the noninvasive diagnosis of DH.

Utilidad de la ecografía vésico-prostática en el diagnóstico de obstrucción/hiperactividad en varones con HBP / Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH

OBJETIVO: Determinar la utilidad de la ecógrafía prostática para el diagnóstico de obstrucción infravesical(OIV) y del detrusor hiperactivo(DH).MÉTODOS: Estudio prospectivo sobre 39 pacientes que consultaron por STUI. Se realizó historia clínica, IPSS, tacto rectal, ecografía abdominal midiendo grosor del detrusor, peso del detrusor, volumen prostático, longitud lóbulo medio(LLM) y estudio urodinámico (EUD) con obtención del número de Abrams-Griffiths y nomograma ICS. Se compararon medias con el test de U Mann-Whitney y se construyeron curvas ROC determinando los puntos de corte óptimos de sensibilidad y especificidad, con una significación estadística p < 0.05.RESULTADOS: La edad media de los 39 pacientes fue 63,1 años(DE:7,8 años) con IPSS medio de 14 puntos(DE:6) siendo la puntuación media de los síntomas de urgencia de 5,9 puntos(DE:3,1).El 53,8% de pacientes presentaron OIV en el EUD y el 43,6% DH. Resultaron significativas las diferencias entre el Qmax de la flujometría libre(p=0,015) y la LLM(p=0,003) entre los pacientes con OIV y los que no . Las curvas ROC mostraron un área bajo la curva para la LLM de 0,772 con punto de mayor sensibilidad y especificidad en 10,5mm(S:90%,E:73%,VPP:76%,VPN:85%). No hubieron diferencias en ningún parámetro entre pacientes con y sin DH.CONCLUSIONES: La medición de la LLM mediante ecografía en pacientes con STUI presenta una alta sensibilidad/especificidad para el diagnóstico de OIV con punto de corte 10,5mm. Es bien tolerada, económica y rápida. En nuestro estudio no se ha mostrado como una prueba eficaz en el diagnóstico no invasivo del hiperactividad del DH(AU)

OBJECTIVE: To determine the utility of prostate ultrasound in the diagnosis of infravesical obstruction (IVO) and detrusor hyperactivity(DH).METHODS: Prospective study with 39 patients consulting for LUTS. Clinical history was compiled, IPSS was determined, a digital rectal exam was performed, abdominal ultrasound was used to calculate detrusor thickness/weight, prostate volume, and middle lobe length (MLL). Urodynamic study (UD) was performed with determination of the Abrams-Griffiths number and ICS nomogram. Mean values were compared with Mann-Whitney U-test, and ROC curves were plotted determining the cutoff points for optimum sensitivity/specificity.RESULTS: Mean age was 63.1 years (SD: 7.8), with a mean IPSS score of 14 (SD: 6). 53.8% of the patients presented IVO at UD evaluation, and 43.6% DH. The differences between free flowmetry Qmax(p=0.015) and MLL (p=0.003) between patients with and without IVO proved significant. The ROC curves yielded an AUC for middle lobe length of 0.772, with a maximum sensitivity and specificity cutoff point at 10.5 mm (sensitivity 90%, specificity 73%, PPV 76%, NPV 85%). There were no significant differences in any parameter between patients with and without DH.CONCLUSION: Ultrasound MLL measurement in patients with LUTS offers high sensitivity/specificity in diagnosing IVO, with a cutoff point of 10.5 mm. In our study it wasn’t effective in the noninvasive diagnosis of DH(AU)