Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia.

OBJECTIVES: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks. METHODS: Pre-operative, post-operative 1st and 6th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared. RESULTS: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1st- and 6th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively. CONCLUSION: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

OBJETIVOS: La termoterapia bipolar por radiofrecuencia es uno de los métodos adoptados en pacientes con alto riesgo quirúrgico. El objetivo de este estudio es comparar el efecto de la termoterapia de radiofrecuencia bipolar y los métodos de RTUP en los síntomas de vaciado y en las tasas de complicaciones posoperatorias, especialmente en pacientes con alto riesgo quirúrgico. MÉTODOS: Se compararon el IPSS, el Qmax, la calidad de vida, los volúmenes de próstata y las complicaciones posoperatorias de los pacientes sometidos a RTUP y RF para la HBP preoperatorios, posoperatorios al primer y sexto mes. RESULTADOS: En el grupo de RF, la mediana preoperatoria del IPSS fue de 30, el volumen prostático de 41.5 cc, el PVR de 80 ml y el Qmax de 5.85 ml/seg.; En el grupo RTUP estos fueron 29, 40 cc, 85 ml y 5.3 ml/seg, respectivamente. En el grupo de RF bipolar, los valores medianos postoperatorios del primer y sexto mes fueron IPSS 18, 21; volumen de próstata 40, 40; PVR 40, 35; Qmax 10.9, 9.15 y en el grupo TURP IPSS 9, 8; volumen de próstata 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectivamente. CONCLUSIÓN: La termoterapia de RF bipolar es un método de tratamiento aplicable para pacientes con HPB con alto riesgo quirúrgico.

Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up.

INTRODUCTION: The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM: The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS: Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS: The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS: There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Resección transuretral en bloque vs. resección transuretral convencional para el cáncer de vejiga primario no músculo-infiltrante: metaanálisis / En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis

Introducción Se realizó un metaanálisis para evaluar el efecto de la resección transuretral en bloque en comparación con la resección transuretral convencional para el cáncer de vejiga primario no músculo-infltrante. Métodos Se realizó una búsqueda sistemática en la literatura hasta enero de 2022 y se incluyeron 28 estudios con 3.714 sujetos con cáncer de vejiga primario no músculo-infltrante al inicio del estudio; a 1.870 de ellos se les efectuó una resección transuretral en bloque y a 1.844 una resección transuretral convencional para el cáncer de vejiga primario no músculo-infltrante. Se calculó la odds-ratio (OR) y la diferencia de medias (DM) con intervalos de confianza (IC) del 95% para evaluar el efecto de una y otra en el cáncer primario de vejiga no invasivo por métodos dicotómicos o continuos con un modelo de efectos aleatorios o fijos. Resultados La resección transuretral en bloque obtuvo valores significativamente menores en términos de recurrencia a los 24 meses (OR: 0,63; IC 95%: 0,50-0,78; p<0,001), tiempo de sondaje (DM: –0,66; IC 95%: –1,02-[–0,29]; p<0,001); duración de la estancia hospitalaria (DM: –0,95; IC 95%: –1,55-[–0,34]; p=0,002), tiempo de irrigación vesical postoperatoria (DM: –6,06; IC 95%: –9,45-[–2,67]; p<0,001), contracción del nervio obturador (OR: 0,08; IC 95%: 0,02-0,34; p=0,03) y perforación de la vejiga (OR: 0,14; IC 95%: 0,06-0,36; p<0,001) y no hubo diferencias significativas en cuanto a la recurrencia a los 12meses (OR: 0,79; IC 95%: 0,61-1,04: p=0,09), tiempo quirúrgico (DM: 0,67; IC 95%: –1,92-3,25; p=0,61) y estenosis uretral (OR: 0,46; IC 95%: 0,14-1,47; p=0,19) en comparación con la resección transuretral convencional para sujetos con cáncer de vejiga primario no invasivo...(AU)

Introduction We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. Methods A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. Results En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; P<0.001), catheterization-time (MD: –0.66; 95%CI: –1.02-[–0.29]; P<0.001), length of hospital stay (MD: –0.95; 95%CI: –1.55-[–0.34]; P=0.002), postoperative bladder irrigation duration (MD: –6.06; 95%CI: –9.45-[–2.67]; P<0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; P=0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: P<0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; P=0.09), the operation time (MD: 0.67; 95%CI: –1.92-3.25; P=0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; P=0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects... (AU)

How has the COVID-19 pandemic affected patients with primary bladder cancer?

PURPOSE: The COVID-19-induced effects of primary bladder cancer (BC) patients have not yet been clarified. The aim of this study was to investigate the effects of the pandemic on the diagnosis, treatment, and follow-up of primary BC patients. MATERIAL AND METHODS: A retrospective single-center analysis was made of all patients who underwent diagnostic and surgical procedures due to primary BC between November 2018 and July 2021. A total of 275 patients were identified and allocated to one of the groups: Pre-COVIDBC (BC diagnosed before the COVID-19 pandemic) or COVIDBC (during the pandemic). RESULTS: The BC patients diagnosed during the pandemic were mostly at higher stages (T2) (p = 0.04), the risk of non-muscle invasive BC (NMIBC) was higher (p = 0.02), and recurrence and progression scores were increased (p = 0.001) compared to patients diagnosed before the pandemic. The time to surgery from diagnosis (p = 0.001) and symptom duration (p = 0.04) were significantly prolonged during the pandemic and the rate of follow-up significantly decreased (p = 0.03). CONCLUSIONS: The study results highlight the significant increase in muscle invasive BC and the very high risk of NMIBC in patients presenting during the COVID-19 pandemic.

ANTECEDENTES: Los efectos inducidos por la COVID-19 en pacientes con cáncer de vejiga primario no están aclarados actualmente. OBJETIVO: Investigar los efectos de la pandemia en el diagnóstico, el tratamiento y el seguimiento del cáncer de vejiga primario. MÉTODO: Se realizó un análisis retrospectivo unicéntrico de todos los pacientes que se sometieron a procedimientos diagnósticos y quirúrgicos por cáncer primario de vejiga durante noviembre de 2018 y julio de 2021. Se incluyeron 275 pacientes en el estudio. Los pacientes fueron asignados a uno de dos grupos: pre-COVIDBC (antes de la pandemia) o COVIDBC (durante la pandemia). RESULTADOS: Los pacientes con cáncer de vejiga diagnosticados durante la pandemia se encontraban en su mayoría en estadios más altos (T2) (p = 0.04), el grupo de riesgo era más alto en el cáncer de vejiga no invasivo del músculo (p = 0.02), y la recurrencia y las puntuaciones de progresión aumentaron (p = 0.001) en comparación con antes del período pandémico. Además, el tiempo hasta la cirugía desde el diagnóstico (p = 0.001) y la duración de los síntomas (p = 0.04) aumentaron considerablemente durante la pandemia, y la tasa de seguimiento disminuyó significativamente (p = 0.03). CONCLUSIONES: Destaca el aumento significativo del cáncer de vejiga invasivo del músculo y del cáncer de vejiga no invasivo del músculo de muy alto riesgo durante la pandemia.

En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis.

INTRODUCTION: We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. METHODS: A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. RESULTS: En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; p < 0.001), catheterization-time (MD: -0.66; 95%CI: -1.02-[-0.29]; p < 0.001), length of hospital stay (MD: -0.95; 95%CI: -1.55-[-0.34]; p = 0.002), postoperative bladder irrigation duration (MD: -6.06; 95%CI: -9.45-[-2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: -1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. CONCLUSIONS: En-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.

Manejo del cáncer de vejiga invasor de músculo con enfoque preservador de órgano: terapia trimodal / Management of muscle-invasive bladder cancer with an organ-sparing approach: trimodal therapy

El cáncer de vejiga es una patología frecuente del tracto genitourinario, cuyo tratamiento acarrea morbilidad y alteración de la calidad de vida y en particular en el subgrupo de pacientes con tumores vesicales clasificados como invasores de músculo. En los últimos años se han venido buscando alternativas terapéuticas para la cistectomía radical + linfadenectomía pélvica extendida, que es en la actualidad el estándar de manejo para los pacientes con carcinoma de vejiga invasor de músculo. Con el advenimiento de perfiles de manejo oncológico menos ablativos pero sin sacrificar resultados oncológicos y con las nuevas técnicas de radioterapia y quimioterapia, las modalidades terapéuticas preservadoras de órgano como la terapia trimodal (resección transuretral de tumor vesical + quimioterapia + radioterapia) se convierte en una alternativa terapéutica viable y con resultados oncológicos satisfactorios a largo plazo. Objetivo y metodología: Con esta revisión se pretende mostrar la actualidad de la terapia trimodal en el manejo de los tumores vesicales con invasión muscular, definir los mejores pacientes a considerar para recibir esta terapia, exponer los resultados oncológicos comparados con el estándar de manejo y los resultados en calidad de vida. También se propone un algoritmo de manejo y se presentar las recomendaciones al respecto en guías de práctica clínica. Conclusiones: La terapia trimodal es una alternativa al estándar de manejo que conduce a resultados oncológicos aceptables y puede considerarse una opción de tratamiento en pacientes bien seleccionados.

Introduction: Bladder cancer is a frequent pathology of the genitourinary tract, whose treatment causes morbidity and impaired quality of life, particularly in the subgroup of patients with bladder tumors classified as muscle invaders. In recent years, therapeutic alternatives have been sought for radical cystectomy + extended pelvic lymphadenectomy, which is currently the standard of care for patients with muscle-invasive bladder carcinoma. With the advent of less ablative oncological management profiles but without sacrificing oncological results and with new radiotherapy and chemotherapy techniques, organ-sparing therapeutic modalities such as trimodal therapy (transurethral resection of bladder tumor + chemotherapy + radiotherapy) becomes a viable therapeutic alternative with satisfactory long-term oncological results. Objective and methodology: This review aims to show the current status of trimodal therapy in the management of muscle-invasive bladder tumors, define the best patients to consider for receiving this therapy, present the oncological results compared with the management standard and the results in quality of life. A management algorithm is also proposed and recommendations in this regard are presented in clinical practice guidelines. Conclusions: Trimodal therapy is an alternative to standard management that leads to acceptable oncological outcomes and can be considered a treatment option in well-selected patients.

Effect of Re-TUR time on recurrence and progression in high-risk non-muscle-invasive bladder cancer.

OBJECTIVE: We aimed to investigate the significance of time to re-staging transurethral resection (re-TUR) on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer as a prospective randomized study. METHODS: The patients were randomly separated into three groups according to Re-TUR timing. In Groups 1, 2, and 3, the time interval between initial and re-TUR was 14-28 days, 29-42 days, and 43-56 days, respectively. Cox regression analysis was used to assess the effect of time from initial TUR to re-TUR on oncological outcomes. RESULTS: Twenty patients in Group 1 (14-28 days), 22 patients in Group 2 (29-42 days), and 29 patients in Group 3 (43-56 days) completed the study. Kaplan-Meier plots showed no differences in recurrence-free survival (RFS) and progression-free survival (PFS) rates between the three groups. Cox regression analysis demonstrated that only tumor number was found to be a prognostic factor on RFS rates. CONCLUSION: Our prospective study demonstrated that time laps from initial TUR to re-TUR did not significantly affect on RFS and PFS rates.

OBJETIVO: Nuestro objetivo fue investigar la importancia del tiempo para volver a estadificar la resección transuretral (re-RTU) en las tasas de recurrencia y progresión en pacientes con cáncer de vejiga no músculo invasivo de alto riesgo como un estudio prospectivo aleatorizado. MÉTODO: Los pacientes se separaron aleatoriamente en 3 grupos de acuerdo con el tiempo de Re-TUR. En el grupo 1, 2 y 3, el intervalo de tiempo entre la RTU inicial y la nueva fue de 14 a 28 días, 29 a 42 días y 43 a 56 días, respectivamente. Cox para evaluar el efecto del tiempo desde la RTU inicial hasta la nueva RTU sobre los resultados oncológicos. RESULTADOS: Veinte pacientes del grupo 1, 22 pacientes del grupo 2, 29 pacientes del grupo 3 completaron el estudio. Los gráficos de Kaplan-Meier no mostraron diferencias en las tasas de SLR y SLP entre los tres grupos. El análisis de regresión de Cox demostró que solo se encontró que el número de tumores era un factor pronóstico en las tasas de RFS. CONCLUSIÓN: Nuestro estudio prospectivo demostró que los lapsos de tiempo desde la RTU inicial hasta la nueva RTU no afectaron significativamente las tasas de SLR y SLP.

La dosis única de instilación intravesical postoperatoria inmediata de quimioterapia no es superior al lavado continuo con suero / Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation

Introducción y objetivos: Evaluar si existe alguna diferencia entre el efecto de la instilación intravesical de quimioterapia postoperatoria inmediata (IQPI) y el del lavado vesical continuo con suero salino (LVCS) en la recidiva del cáncer de vejiga (CV) en pacientes con CV primario de riesgo bajo o intermedio sin invasión muscular (CVSIM).Materiales y métodos: Se revisaron retrospectivamente las historias clínicas de 1.482 pacientes sometidos a resección transuretral de tumor de vejiga entre marzo de 1994 y agosto de 2020. Los pacientes se dividieron en 2 grupos según el tratamiento administrado de IQPI y/o LVCS (Grupo 1: solo LVCS; Grupo 2: LVCS tras IQPI). Los pacientes con CVSIM de riesgo bajo e intermedio también se dividieron en subgrupos según el tipo de tratamiento administrado: IQPI y/o LVCS.Resultados: Se incluyeron 594 pacientes con CVSIM primario. De los pacientes, 86 (14,5%) eran mujeres y 508 (85,5%) eran varones, con una edad media de 69 (60-78) años. La frecuencia de pacientes en el grupo 1 y el grupo 2 fue de 361 (60,8%) y 233 (39,2%), respectivamente. Se observó enfermedad recurrente en 213 (35,9%) pacientes. No hubo diferencias entre los grupos al comprar la frecuencia de la enfermedad recurrente, la mediana de tiempo hasta la primera recidiva y la frecuencia de la recidiva en los primeros 12 meses (p=0,064; p=0,671 y p=0,145, respectivamente). Las tasas de recidiva en los pacientes con CVSIM de bajo riesgo fueron menores cuando recibieron tratamiento con «LVCS tras IQPI” en comparación con «solo LVCS» (p=0,042). Sin embargo, no se observaron diferencias en los subgrupos de CVSIM de bajo riesgo al comparar las características patológicas de los tumores recurrentes como el número, el tamaño, el grado, el estadio y la presencia de carcinoma in situ (p>0,05, para cada una. (AU)

Introduction and objectives: To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation(CSBI) in terms of bladder cancer(BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC).Materials and methods: Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status (Group 1: CSBI alone; Group 2: CSBI following IPOIC). Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status.Results: A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60-78) years. The frequency of patients in group 1 and group 2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P=.064, P=.671, and P=.145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with “CSBI following IPOIC” when compared to “CSBI alone” (P=.042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P>.05, for each).Conclusions“CSBI following IPOIC” combination was not superior to “CSBI alone” for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC. (AU)

Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation.

INTRODUCTION AND OBJECTIVES: To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation (CSBI) in terms of bladder cancer (BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC). MATERIALS AND METHODS: Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status [Group-1 = CSBI alone; Group-2 = CSBI following IPOIC]. Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status. RESULTS: A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60-78) years. The frequency of patients in Group-1 and Group-2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P = .064, P = .671, and P = .145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with "CSBI following IPOIC" when compared to "CSBI alone" (P = .042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P > .05, for each). CONCLUSIONS: "CSBI following IPOIC" combination was not superior to "CSBI alone" for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC.

Flujometría manual en la evaluación clínica y terapéutica de pacientes con hiperplasia prostática benigna / Manual flowmetry in the clinical and therapeutic evaluation of patients with benign prostatic hyperplasia

Introducción: La hiperplasia prostática benigna es una enfermedad frecuente que aumenta su incidencia con la edad. Su patogenia no está clara aún y su cuadro clínico típico es la obstrucción urinaria progresiva con pérdida de calidad de vida. Objetivos: Evaluar el valor predictivo de la flujometría manual en la definición de la conducta terapéutica en pacientes con hiperplasia prostática benigna y determinar la evolución de dichos pacientes en el tiempo. Método: Se realizó un estudio descriptivo, prospectivo y longitudinal de 50 pacientes, diagnosticados como portadores de hiperplasia prostática benigna, desde los puntos de vista clínico e imagenológico, atendidos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2017 hasta igual periodo del 2019. Resultados: La flujometría manual realizada al inicio demostró que 62,0 % de la muestra tenía una tasa de flujo urinario promedio por debajo del rango fisiológico y 22,0 % se encontraba en rango limítrofe o dudoso. Recibieron tratamiento quirúrgico 37 pacientes (74,0 %); 13 (26,0 %) fueron medicados y con seguimiento clínico. Se realizó la resección transuretral de la próstata con una rápida recuperación de los pacientes y en solo 2,0 % hubo complicaciones. Conclusiones: La flujometría manual resultó útil para determinar la conducta a seguir en la mayoría de los pacientes estudiados y en el seguimiento a corto plazo de quienes fueron operados.

Introduction: The benign prostatic hyperplasia is a frequent disease that increases its incidence with the age. Its pathogenesis is not still clear and its typical clinical pattern is the progressive urinary obstruction with loss of life quality. Objectives: To evaluate the predictive value of manual flowmetry in the definition of the therapeutic behavior in patients with benign prostatic hyperplasia and to determine the evolution of these patients as time goes by. Method: A descriptive, prospective and longitudinal study of 50 patients diagnosed with benign prostatic hyperplasia was carried out, from the clinical and imaging points of view, who were assisted in Saturnino Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2017 to the same period in 2019. Results: The manual flowmetry carried out demonstrated at the beginning that 62.0 % of the sample had a rate of average urinary flow below the physiologic range and 22.0 % was in bordering or doubtful range. Thirty seven patients received surgical treatment (74.0 %); thirteen patients (26.0 %) received medication and with clinical follow up. The transurethral resection of prostate was carried out with a quick recovery of the patients and there were complications just in a 2.0 %. Conclusions: The manual flowmetry was useful to determine what to do in most of the studied patients and in the short term follow up of those who were operated.

Tratamiento quirúrgico de la hiperplasia prostática benigna: comparación entre enucleación láser, resección trans uretral y adenomectomía abierta

Objetivo: Comparar el resultado actual de tres técnicas quirúrgicas en pacientes intervenidos por Hiperplasia Benigna de Próstata (HPB); Enucleación láser de próstata (HoLEP), Resección transuretral (RTU) y Prostatectomía Abierta (PA). Enfermedad que actualmente presenta cambios en su presentación clínica y mayores comorbilidades al momento de la cirugía. Materiales y Método: Análisis retrospectivo de 1. 211 pacientes consecutivos e intervenidos en un mismo centro por HPB entre 2008 y 2017 y con al menos 6 meses de evaluación posoperatoria. Se registró las características periperatorias y comorbilidades, comparando los resultados intra y post operatorios obtenidos según la técnica quirúrgica empleada. Se realizó análisis uni y bivariados en programa SPSS versión 17. Para comparar variables categóricas empleamos test exacto de Fisher y para las variables continuas la prueba de Mann-Whitney. Resultados: Al momento de la cirugía 769 pacientes (63,5%) se encuentran en terapia médica por HPB, 268 (22,1%) presentan retención urinaria y 212 (17,5%) se encuentran en terapia anticoagulante-antiagregante. Se realizó HoLEP en 423 pacientes (36,9%), RTU en 651 (56,9%) y PA en 71 (6,2%). Aquellos intervenidos por HoLEP tienen significativa mayor frecuencia de terapia anticoagulante preoperatoria que RTU (9,2% v/s 4,9 %), manteniendo similar tasa de transfusión en post operatorio (0,5%). La mayor necesidad de transfusión la presentan los intervenidos por PA 5,6%. El tiempo de cateterismo y estadía hospitalaria es significativamente más breve en quienes se someten a HoLEP; 3,7 días v/s 4,4 en RTU y 7,1 en PA. También resultan determinantes del tiempo estadía hospitalaria la edad, presencia de cardiopatía coronaria y falla renal. Al sexto mes de la cirugía los pacientes intervenidos por HoLEP tienen un significativo mejor flujo urinario máximo y menor volumen residual. Conclusiones: En esta serie, los pacientes con HBP al momento de requerir cirugía presentan condiciones que se asocian a mayor tiempo de hospitalización: edad, cardiopatía coronaria y falla renal. Confirmamos que aquellos intervenidos con HoLEP registran una hospitalización significativamente más breve y resultados funcionales similares a RTU y PA.

Aim: To compare the current results of three surgical techniques in patients operated on for Benign Prostate Hyperplasia (BPH); Laser Enucleation of the Prostate (HoLEP), Transurethral Resection (TURP) and Open Prostatectomy (PA). Disease that currently presents changes in its clinical presentation and greater comorbidities at the time of surgery. Materials and Method: Retrospective analysis of 1211 consecutive patients operated on in the same center for BPH between 2008 and 2017 and with at least 6 months of postoperative evaluation. The periperative characteristics and comorbidities were recorded, comparing the intra- and post-operative results obtained according to the surgical technique used. A univariate and bivariate analysis was performed using SPSS version 17. To compare categorical variables, we used Fisher's exact test and the Mann-Whitney test for continuous variables. Results: At the time of surgery 769 patients (63.5%) were on medical therapy for BPH, 268 (22.1%) had urinary retention and 212 (17.5%) were on anticoagulant-antiplatelet therapy. HoLEP was performed in 423 patients (36.9%), TURP in 651 (56.9%) and PA in 71 (6.2%). Those operated on by HoLEP had a significantly higher frequency of preoperative anticoagulant therapy than TURP (9.2% vs. 4.9%), maintaining a similar transfusion rate postoperatively (0.5%). The greatest need for transfusion is presented by those operated on by AP 5.6%. The time of catheterization and hospital stay is significantly shorter in those who undergo HoLEP; 3.7 days v / s 4.4 in TUR and 7.1 in PA. Age, presence of coronary heart disease and kidney failure are also determinants of the length of hospital stay. At the sixth month after surgery, patients operated on by HoLEP had a significantly better peak urinary flow and lower residual volume. Conclusions: In this serie, patients with BPH at the time of requiring surgery, presents conditions that are associated with a longer hospitalization time: age, coronary heart disease and kidney failure. We confirmed that those who underwent HoLEP had a significantly shorter hospitalization and functional results, similar to TURP and AP

Factores asociados a infección de vías urinarias luego de una prostatectomía / Factors Associated with Urinary Tract Infection after Prostatectomy

Introducción y Objetivo La cirugía de próstata es un procedimiento frecuente en varones mayores. Existen diferentes técnicas, cuya elección depende de la patología a tratar, de la experiencia del especialista, y de la disponibilidad técnica. Entre sus complicaciones se encuentra la infección del tracto urinario, que ocasiona incremento en morbimortalidad y costos para el sistema de salud. El objetivo principal de este estudio fue evaluar los factores relacionados con la aparición de infección urinaria luego de este tipo de cirugía. Materiales y Métodos Se realizó un estudio de casos y controles en una población de pacientes sometidos a prostatectomía del 2018 hasta principios del 2020 en Medellín, Colombia. Los casos correspondieron a los pacientes que presentaron infección de vías urinarias hasta 30 días tras la prostatectomía. Se estimó la asociación entre casos y controles por medio del cálculo de la razón de disparidad (RD), la cual se ajustó con una regresión logística y con un modelo aditivo generalizado multivariado. Resultados Se identificaron 96 casos incidentes de infección del trato urinario luego de la prostatectomía, con una prevalencia de 8.99%. La frecuencia de solicitud de urocultivo preoperatorio fue de 52,92% (intervalo de confianza del 95% [IC95%]: 48,34­ 57,44%). Las variables independientemente asociadas con la aparición de infección urinaria fueron: solicitud de urocultivo prequirúrgico, número de dosis, y tipo de antibiótico usado para la profilaxis. Particularmente, se encontró como factor protector el uso de aminoglucósidos. En los pacientes con infección urinaria, los principales gérmenes aislados fueron: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis y Serratia marcescens.

Introduction and Objective Prostate surgery is a common procedure among older men. There are different techniques, and the choice depends on the pathology to be treated, the experience of the specialist, and the technical availability. Among its complications is urinary tract infection, which causes increased morbidity and mortality and costs for the health system. The main objective of the present study was to evaluate the factors related to the onset of urinary tract infection after prostate surgery. Materials and Methods A case-control study was conducted in a population of patients undergoing prostatectomy from 2018 to early 2020 in the city of Medellín, Colombia. The cases corresponded to patients who presented urinary tract infection up to 30 days after prostatectomy. The association between cases and controls was estimated by calculating the odds ratio (OR), which was adjusted with logistic regression and a multivariate generalized additive model. Results We identified 96 incident cases of urinary tract infection after prostatectomy, with a prevalence of 8.99%. The frequency of requests for preoperative urine culture was of 52.92% (95% confidence interval [95%CI]: 48.34 - 57.44). The independently associated variables were: request for preoperative urine culture, number of doses, and type of antibiotic used for prophylaxis. In particular, the use of aminoglycosides in prophylaxis schemes was found to be a protective factor. The main germs isolated were: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis, and Serratia marcescens. Conclusion The present study shows that factors such as the preoperative request for urine culture and the use of aminoglycosides for surgical prophylaxis influence the probability of developing urinary tract infection after prostatectomy.

Complicaciones postoperatorias en pacientes con hiperplasia benigna de próstata según técnica quirúrgica

RESUMEN Introducción: La hiperplasia benigna de próstata tiene elevada prevalencia en mayores de 50 años. En quienes fracasa o es mal tolerado el tratamiento médico, se plantea cirugía. Objetivo: Analizar las complicaciones postoperatorias en pacientes operados por hiperplasia benigna de próstata, según diferentes técnicas. Métodos: Se analizaron 161 historias clínicas de pacientes de 60 o más años de edad, con diagnóstico de hiperplasia benigna prostática, intervenidos quirúrgicamente con las técnicas: adenomectomía abierta transvesical, retropúbica y endoscópica monopolar. Resultados: La variación de la hemoglobina ≥ 3mg/dl, con la técnica transvesical fue 17 % y con la retropúbica 27,3 %. El tiempo de sondaje vesical ≤ 4 días en la transvesical un 48,9 %; > 4 a < 7 días en la retropúbica en 59,1 % y ≤ 4 días en la endoscópica monopolar 68,5 %. La estancia hospitalaria ≥ de 5 días, en la transvesical 51,1 % y en la retropúbica 59,9 %; de 1 a < 3 días, con la endoscópica monopolar, 58,7 %. La infección del tracto urinario fue más frecuente con la transvesical (31,9 %), la infección del sitio operatorio (17 %); mientras que la orquiepididimitis fue más frecuente en la retropúbica (40,9 %). El síndrome posresección transuretral prostática monopolar, se presentó en el 17,4 % de los operados. Conclusión: La adenomectomía retropúbica fue la técnica quirúrgica con mayor frecuencia de complicaciones y la resección transuretral la de menor frecuencia. La retención aguda de orina por técnica retropúbica, fue la complicación más frecuente.

ABSTRACT Introduction: Benign prostate hyperplasia has a high prevalence in people over 50 years of age. In those who fail or is poorly tolerated medical treatment, surgery is considered. Objective: To analyze postoperative complications in patients operated on for benign prostatic hyperplasia, according to different techniques. Methods: 161 medical records of patients 60 years of age or older, with a diagnosis of benign prostatic hyperplasia, who underwent surgery with the techniques: open transvesical, retropubic and monopolar endoscopic adenomectomy were analyzed. Results: The variation of hemoglobin ≥ 3mg / dl, with the transvesical technique was 17% and with the retropubic one 27.3%. The time of bladder catheterization ≤ 4 days in the transvesical one 48.9%; > 4 to <7 days in the retropubic in 59.1% and ≤ 4 days in the monopolar endoscopic 68.5%. The hospital stay ≥ 5 days, in the transvesical 51.1% and in the retropubic 59.9%; from 1 to <3 days, with the monopolar endoscopic, 58.7%. Urinary tract infection was more frequent with transvesical (31.9%), surgical site infection (17%); while epididymo-orchitis was more frequent in retropubic (40.9%). Monopolar prostatic transurethral post-resection syndrome appeared in 17.4% of those operated on. Conclusion: Retropubic adenomectomy was the surgical technique with the highest frequency of complications and transurethral resection the least frequent. Acute retention of urine by retropubic technique was the most frequent complication.

Vapoenucleación prostática con láser Tulio. ¿Es igual de segura y efectiva en pacientes ancianos? Análisis por puntuación de propensión de los resultados funcionales y perioperatorios tempranos / Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes

Objetivo: Evaluar la seguridad y efectividad de la vapoenucleación prostática con laser Tulio (TuLEP) en una cohorte seleccionada de pacientes ancianos en comparación con pacientes «más jóvenes».Material y métodosSe realizó un análisis retrospectivo de los pacientes consecutivos que se sometieron a TuLEP entre septiembre de 2018 y febrero de 2020. Tras aplicar los criterios de inclusión/exclusión, los pacientes se estratificaron según el punto de corte de 75 años sugerido por la OMS: el grupo A incluyó a los pacientes < 75 años; el grupo B incluyó a los pacientes > 75 años.La evaluación preoperatoria incluyó una consulta con el urólogo, el valor del antígeno prostático específico (PSA), el International Prostate Symptom Score (IPSS) y quality of life (QoL), ecografía transrectal para estimar el volumen prostático (PVol) y uroflujometría para evaluar los valores preoperatorios de maximum urinary flow rate (Qmax) y average urinary flow rate (Qave), así como el volumen residual postmiccional (PVR). Se analizaron los datos perioperatorios y postoperatorios con un seguimiento de 3 meses.ResultadosTras el análisis de puntuación de propensión, 51 pacientes fueron emparejados 1:1 frente a otros 51 con base en PVol, PSA, Qmax, IPSS y QoL. Los pacientes eran comparables al inicio excluyendo la edad 65 (IQR 59-70) vs. 79 (IQR 77-82) años, Grupo A vs. grupo B, respectivamente (valor p < 0,001).No se encontraron diferencias en cuanto al descenso de la hemoglobina, la tasa de complicaciones, el tiempo de cateterismo y la duración de la estancia hospitalaria. Los pacientes del grupo A (más jóvenes) experimentaron una mejora significativamente mayor en cuanto al valor absoluto de Qmax, Qave y ΔQmax a los 30 días. A los 90 días de seguimiento, las diferencias entre los grupos desaparecieron.Durante los 90 días de seguimiento, no se encontraron diferencias significativas en la tasa de reingreso ni se requirieron reintervenciones. (AU)

Purpose: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to “younger” patients.Materials and MethodsWe performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old.Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.ResultsAfter propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001).No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared.Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. (AU)

Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes.

PURPOSE: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients ≤75 years-old; Group B included patients >75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. RESULTS: After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, P-value <.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. CONCLUSIONS: In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.

Unusual case of infectious endocarditis in a patient subjected to transurethral resection of the prostate (TURP) without cardiovascular risk factors. / Endocarditis en un paciente sujeto a RTU de próstata sin factores de riesgo cardiovascular.

OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard for the treatment of obstructive prostatic hyperplasia. A bacteremia leading to infectious endocarditis (IE) can be the result of urological procedures. IE post TURP is rare. METHODS: We report an unusual case of an infectious endocarditis complicating TURP for benign prostatic hyperplasiain absence of known previous cardiovascular risk factors or conditions. RESULTS AND CONCLUSIONS: The patient developed intermittent episodes of fever lasting more than two months starting 3 weeks from hospital discharge, and he was never referred to the hospital by his general practitioner, until he was evaluated by his Surgeon, admitted to the Emergency Department and diagnosed with infectious endocarditis, later dying for cardiac arrest before getting a cardiac valve replacement. This report aims to be a reminder of how invasive procedures can trigger secondary distant complications that should be taken into account while assessing a post-operative patient.

OBJETIVO: La resección transuretral de próstata es el gold estándar en el tratamiento de la hiperplasia benigna de próstata. Una bacteriemia que comporta endocarditis infecciosa (EI) puede ser como resultado de procedimientos urológicos. La EI post RTU próstata es rara. METODOS: Describimos un caso inusual de endocarditis infecciosa complicada post RTU de próstata por hiperplasia benigna de próstata en ausencia de factores de riesgo cardiovascular conocidos u otras patológicas. RESULTADOS Y CONCLUSIONES: El paciente desarrolló episodios intermitentes de fiebre por más de 2 meses iniciándose a las 3 semanas del alta hospitalaria. El paciente nunca fué mandado al hospital por el medico de familia hasta que fue evaluado por su cirujano, ingresado en el servicio de urgencias y diagnosticado de endocarditis infecciosa. Finalmente murió de parada cardiorespiratoria antes de someterse a cirugía de sustitución valvular. Este caso pretende recordar lo invasivo que es el procedimiento y que puede desencadenar complicaciones secundarias que deben tenerse en consideración en el contexto postoperatorio del paciente.

Risk factors for perioperative complications in transurethral prostate resection in patients at a Colombian institution. / Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de Colombia.

OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I - II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 - 4.39), INR (RR: 7.59, IC95%:4.63 - 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 - 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 - 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity.

OBJETIVO: Determinar la tasa de complicaciones y los factores de riesgo para complicaciones perioperatorias tempranas de la Resección Transuretral de Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio de cohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna (HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las características basales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. RESULTADOS: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%) fueron intrahospitalarias. Según la clasificación Clavien Dindo el 14,79% fueron complicaciones grado I y II: la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tracto urinario (4,64%) y disfunción de la sonda uretrovesical (1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 ­ 4,39), aumento del valor del INR por unidad (RR: 7,59, IC95%: 4,63 ­ 12,44) y cada día adicional de irrigación vesical (RR: 1,32, IC95%:1,22 ­ 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02­ 1,05). CONCLUSIONES: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de meno rdel 20%, siendo las complicaciones grados I y II las más frecuentes. Los factores de riesgo encontrados son modificables lo que podría reducir la morbilidad postoperatoria.

Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de colombia / Risk factors for perioperative complications in transurethral resection of the prostate in patients from a Colombian institution

Objetivo: Determinar la tasa de complicaciones y los factores de riesgo para complicacionesperioperatorias tempranas de la Resección Transuretralde Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. Materiales y métodos: Se realizó un estudio decohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna(HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las característicasbasales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. Resultados: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%)fueron intrahospitalarias. Según la clasificación ClavienDindo el 14,79% fueron complicaciones grado I y II:la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tractourinario (4,64%) y disfunción de la sonda uretrovesical(1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 – 4,39), aumento del valor del INRpor unidad (RR: 7,59, IC95%: 4,63 – 12,44) y cadadía adicional de irrigación vesical (RR: 1,32, IC95%:1,22 – 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02– 1,05). Conclusiones: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de menordel 20%, siendo las complicaciones grados I y II lasmás frecuentes. Los factores de riesgo encontrados sonmodificables lo que podría reducir la morbilidad postoperatoria.(AU)

Objetive: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolartransurethral resection of the prostate at a complex careinstitution in Colombia. Material and methods: A mixed cohort study wasconducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolartransurethral resection of the prostate between 2012and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate ofcomplications determined up to 30 postoperative days. Results: A total of 67 patients (19.45%) presentedperioperative complications of which 17 (25.37%)were previously hospitalized. According to the ClavienDindo classification, 14.79% were grade I – II: secondary hematuria was the most reported complication andwas present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The riskfactors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 – 4.39), INR (RR: 7.59, IC95%:4.63 – 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 – 1.42) and urethral catheter use(RR: 1.04, CI95%: 1.02 – 1.05). Conclusions: In this study, the complication rate after bipolar transurethral resection of the prostate was lessthan 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. Therisk factors that were found are modifiable, which couldreduce postoperative morbidity.(AU)

Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes. / Vapoenucleación prostática con láser Tulio. ¿Es igual de segura y efectiva en pacientes ancianos? Análisis por puntuación de propensión de los resultados funcionales y perioperatorios tempranos.

PURPOSE: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. RESULTS: After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. CONCLUSIONS: In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.

Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3 / Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

Introducción y objetivos: Los objetivos de la resección transuretral (RTU) del tumor vesical son la resección completa de las lesiones y la realización de un diagnóstico correcto con el objetivo de estadificar adecuadamente al paciente. Es bien sabido que la presencia de músculo detrusor en el espécimen es un requisito previo para minimizar el riesgo de infraestadificación.La persistencia de enfermedad tras la resección de los tumores vesicales no es infrecuente, y es la razón por la que las guías europeas recomiendan una re-resección transuretral (re-RTU) para todos los tumores T1. Recientemente se ha publicado que, en los casos con inclusión de músculo en el espécimen, la re-RTU no afecta la progresión ni la supervivencia específica del cáncer.Presentamos aquí los factores relacionados con el paciente y el tumor que pueden influir en la presencia de enfermedad residual en la re-RTU.Material y métodosDe nuestra cohorte retrospectiva de 2.451 pacientes con tumores T1G3 primarios tratados inicialmente con bacilo de Calnette-Guérin (BCG), están disponibles los resultados patológicos de 934 pacientes (38,1%) que se sometieron a una re-RTU. El 74% tenía tumores multifocales, el 20% de los tumores tenía más de 3 cm de diámetro y el 26% tenía carcinoma in situ (CIS) concomitante. En este subgrupo de pacientes que se sometieron a una segunda RTU, no hubo enfermedad residual en 267 pacientes (29%) y se presentó enfermedad residual en 667 pacientes (71%): Ta en 378 (40%) y T1 en 289 (31%) pacientes. Se analizaron la edad, el sexo, el estado del tumor (primario/recurrente), la terapia intravesical previa, el tamaño del tumor, la multifocalidad del tumor, la presencia de CIS concomitante y la inclusión de músculo en el espécimen para evaluar los factores de riesgo de enfermedad residual en la re-RTU, tanto en los análisis univariantes, como en las regresiones logísticas multivariantes. (AU)

Introduction and objectives: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging.Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival.We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR.Material and methodsIn our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS.In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. (AU)