Gender trends at the annual Spanish Urologic Association (AEU) meeting: A review of AEU programmes over a 10-year period (2012-2022).

INTRODUCTION: Gender equity in urological meetings is pivotal for fostering diversity and inclusivity in the field. This study aims to evaluate the representation of Spanish urologist and regional disparities, and to assess its alignment with the demographic composition of the urological community. MATERIALS AND METHODS: All urology meetings organized by the AEU between January 2012 and December 2022 were reviewed, including meeting information and details of the faculty. Additionally, we analysed geographic distribution of speakers across 17 different regions. Gender demographics were obtained disaggregating data by sex and year from the Organización Médica Colegial de España (OMC) and from those urologists affiliated to the AEU. RESULTS: Analysing 52 AEU congresses held from 2012 to 2022, encompassing 3,407 speakers, the study found that 95.25% of speakers were from Spain and 89.6% were male speakers. Over the years, there was a positive trend in female speaker representation, increasing by 1.1% annually, slightly lagging the 1.8% annual rise in the number of female urologists in Spain. In specific subfields like functional, transplantation, and oncology sessions, the study revealed a higher representation of women, indicating focused efforts in these areas. Geographically, Madrid, Catalonia and Andalusia exhibited the highest representation. CONCLUSIONS: Although there was a positive trend towards an increased participation of female urologists in Spanish urological meetings, it fails to accurately reflect the proportional increase in the number of women entering the urology profession in recent years. This study underscores the importance of ongoing efforts to ensure diverse and balanced representation in urological forum.

Surgical outcomes in women diagnosed with deep endometriosis involving urological structures.

INTRODUCTION: The prevalence of endometriosis is estimated to be about 10% among women of reproductive age. In about 5-10% of these patients, involvement of urological structures will be developed due to deep endometriosis. Urologists should be familiar with the management of these patients, who will require multidisciplinary care with medical and surgical treatment. MATERIAL AND METHODS: Retrospective study of patients diagnosed with deep endometriosis involving urological structures who underwent surgery performed jointly with gynecology and colorectal surgery departments from June 2012 until June 2021 (60 cases). Urologic symptoms were grouped into 3 groupers for subsequent analysis (storage symptoms, voiding symptoms, and low back pain). RESULTS: Storage symptoms (frequency and urgency) are the most frequent urologic symptoms. Patients with storage symptoms and low back pain showed improvement after surgery. In contrast, patients with voiding symptoms did not improve with surgical treatment. CONCLUSIONS: The prevalence of endometriosis and the likelihood of involving urologic structures require the urologic community to be aware of the pathology. Patients with storage symptoms will improve following excision of the endometriotic nodules. The need for Partial cystectomies with ureteral reimplantation can be safely performed by laparoscopic or robotic approach, even in previously operated patients, without compromising long-term function.

Current status of robotic training during the urology residency: results from a national survey in Spain.

INTRODUCTION AND OBJECTIVES: The increasing number of robotic urological procedures observed in recent years highlights the need to expand training opportunities in robotic surgery. Our objective is to investigate the state of robotic training during urology residency in Spain in order to identify significant deficiencies. MATERIALS AND METHODS: A 20-item online survey was conducted among urology residents in Spain who were registered in the database of the Residents and Young Urologists Group of the Spanish Association of Urology. The survey assessed subjective opinions, institutional aspects, training resources, and experience regarding robotic surgery. A total of 455 email invitations were sent throughout the year 2021. Descriptive analysis of the responses was performed. RESULTS: The participation rate reached 30%, with a total of 135 residents. 52% of respondents lacked access to a robotic system in their institution, of which only 48% could compensate for this deficiency through external rotations. Among those with access to a robotic system, 25% and 23% reported having access to theoretical and practical training, respectively. The existence of a formal training program was low (13%). 85% of the respondents considered robotic surgery training in Spain to be deficient. CONCLUSIONS: Training for Spanish residents in robotic urological surgery is perceived as inadequate, emphasizing the crucial need for improvement in training programs in this field.

Pentafecta evaluation in robot-assisted radical prostatectomy by risk group.

OBJECTIVE: Radical prostatectomy is a therapeutic option in organ-confined prostate cancer. As the development of robotic systems progresses, the approach with this technology has begun to impact the functional and oncological outcomes of urological patients. The objective is to report the rate of pentafecta in patients undergoing robot-assisted radical prostatectomy (RARP) stratified by risk groups. METHOD: Retrospective, observational, descriptive study from 2013 to 2020 that included 112 patients undergoing RARP. RESULTS: A rate of pentafecta at 12 months of follow-up of 35.7% (n = 40) was obtained. In the subanalysis by risk groups, at 1-year follow-up, was obtained an index of 43% (n = 26), 26% (n = 9) and 22% (n = 4) in low-, intermediate-, and high-risk patients, respectively. CONCLUSIONS: Prostatectomy showed functional and oncological results similar to those reported in the literature with robotic approach, regardless of the risk group for prostate cancer.

OBJETIVO: La prostatectomía radical es la alternativa terapéutica de elección en el cáncer de próstata confinado al órgano. Conforme avanza el desarrollo de los sistemas robóticos, el abordaje con esta tecnología ha comenzado a impactar en los desenlaces funcionales y oncológicos de los pacientes urológicos. El objetivo es reportar el índice de pentafecta en pacientes sometidos a prostatectomía radical asistida por robot (PRRA) estratificados por grupos de riesgo. MÉTODO: Estudio retrospectivo, observacional, descriptivo, de 2013 a 2020, que incluyó 112 pacientes sometidos a PRAR. RESULTADOS: Se obtuvo un índice de pentafecta a 12 meses de seguimiento del 35.7% (n = 40). En el subanálisis por grupos de riesgo, al año de seguimiento, se obtuvieron unos índices del 43% (n = 26), el 26% (n = 9) y el 22% (n = 4) en los pacientes de bajo, intermedio y alto riesgo, respectivamente. CONCLUSIONES: La prostatectomía demostró resultados funcionales y oncológicos similares a lo reportado en la literatura con abordaje robótico independientemente del grupo de riesgo del cáncer de próstata.

Quality of information about urologic pathology in English and Spanish from ChatGPT, BARD, and Copilot.

INTRODUCTION AND OBJECTIVE: Generative artificial intelligence makes it possible to ask about medical pathologies in dialog boxes. Our objective was to analyze the quality of information about the most common urological pathologies provided by ChatGPT (OpenIA), BARD (Google), and Copilot (Microsoft). METHODS: We analyzed information on the following pathologies and their treatments as provided by AI: prostate cancer, kidney cancer, bladder cancer, urinary lithiasis, and benign prostatic hypertrophy (BPH). Questions in English and Spanish were posed in dialog boxes; the answers were collected and analyzed with DISCERN questionnaires and the overall appropriateness of the response. Surgical procedures were performed with an informed consent questionnaire. RESULTS: The responses from the three chatbots explained the pathology, detailed risk factors, and described treatments. The difference is that BARD and Copilot provide external information citations, which ChatGPT does not. The highest DISCERN scores, in absolute numbers, were obtained in Copilot; however, on the appropriacy scale it was noted that their responses were not the most appropriate. The best surgical treatment scores were obtained by BARD, followed by ChatGPT, and finally Copilot. CONCLUSIONS: The answers obtained from generative AI on urological diseases depended on the formulation of the question. The information provided had significant biases, depending on pathology, language, and above all, the dialog box consulted.

External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Implante endoscópico de mioblastos autólogos en el tratamiento de la incontinencia urinaria de esfuerzo y evaluación de su eficacia en conejos sometidos a esfinterotomía / Endoscopic implantation of autologous myoblasts for stress urinary incontinence and evaluation of its efficacy in sphincterotomized rabbits

Introducción La incontinencia urinaria de esfuerzo (IUE) constituye uno de los problemas de salud con mayor impacto en la vida de las personas. El objetivo del presente trabajo fue desarrollar una terapia para IUE dentro de la ingeniería de tejidos mediante aislamiento y cultivo de mioblastos autólogos (MAC), su implante endoscópico y el estudio de su eficacia en un modelo de incontinencia por esfinterotomía desarrollado en conejos. Materiales y métodos Se utilizaron conejos Nueva Zelanda, machos, sanos. Los animales fueron primero sangrados para obtención del plasma pobre en plaquetas (PPP) y biopsiados para el aislamiento de mioblastos. Posesfinterotomía, fueron divididos en dos grupos: grupo tratado (representado por aquellos animales que recibieron MAC resuspendidos en PPP) y grupo control (representado por aquellos animales que recibieron solo PPP). Se utilizó el punto de presión de pérdida (LPP) para medir la continencia de ambos grupos en diferentes instancias. Los resultados se evaluaron con modelos de regresión lineal jerárquica. Se efectuaron también estudios histológicos sobre los esfínteres de los conejos una vez finalizado el seguimiento. Resultados No se observaron diferencias estadísticamente significativas entre los valores basales de LPP de cada grupo. Los valores posesfinterotomía de ambos grupos estuvieron por debajo del 50% del valor basal, condición necesaria para considerarlos sujetos incontinentes. Los valores posimplante del grupo tratado fueron superiores al 50% del valor basal, permitiendo suponer una recuperación de la continencia. Se observó una diferencia estadísticamente significativa en los valores de LPP entre los dos grupos de tratamiento (p=0,003). El estudio histológico en el grupo tratado reveló islas interconectadas formadas por fibras musculares, mientras que en el grupo control se observó tejido conectivo periférico a la luz de la uretra e infiltrado inflamatorio. Discusión y conclusiones ... (AU)

Introduction Stress urinary incontinence (SUI) is one of the health problems with more impact on patients’ lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. Materials and methods We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits’ sphincters was also performed at the end of follow-up. Results No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. Discussion and conclusions The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. ... (AU)

La interdisciplinariedad en la cirugía urológica mínimamente invasiva / Interdisciplinarity in Minimally Invasive Urologic Surgery

Introducción: La interdisciplinariedad es el resultado de la puesta en práctica de varias disciplinas, que permite afrontar el objeto de estudio de modo integral y promover el desarrollo de nuevas intervenciones para la solución de problemas. En el campo de la medicina involucra la contribución de diversas disciplinas y la participación de especialistas de diversas áreas que integra el pensamiento de diferentes profesiones o tecnologías para lograr un resultado común. Objetivos: Exponer una visión integral acerca de cómo la interdisciplinariedad ha permitido el desarrollado de la cirugía mínimamente invasiva en la especialidad de urología. Métodos: Se realizó una revisión sistemática y crítica de artículos reportados sobre la interdisciplinariedad en el campo de la cirugía mínimo invasiva, en idioma español e inglés, desde 2005 hasta 2022, en sitios Web (PubMed, SciELO, MedLine, Lilacs y Science Direct. Se referenciaron 22 artículos de los consultados. Conclusiones: Las evidencias reportadas y consultadas ofrecen una visión integral de las diversas intervenciones que certifican la interdisciplinariedad en el campo de la cirugía urológica mínimamente invasiva, que fortalece el marco curricular de la especialidad y permite alcanzar un nivel de profesionalidad significativo, evidenciado en un excelente desempeño profesional(AU)

Introduction: Interdisciplinarity results from implementing several disciplines, allowing to address the object of study comprehensively, as well as promote the development of new interventions to solve problems. In the field of medicine, it involves the contribution of various disciplines and the participation of specialists from different areas, integrating the thinking from different professions or technologies to achieve a common result. Objectives: To present a comprehensive perspective of how interdisciplinarity has allowed the development of minimally invasive surgery in the specialty of urology. Methods: A systematic and critical review was carried out with reported articles on interdisciplinarity in the field of minimally invasive surgery, in Spanish and English, from 2005 to 2022, in Web sites (PubMed, SciELO, MedLine, Lilacs and Science Direct). Twenty-two of the consulted articles were referenced. Conclusions: The reported and consulted evidence offers a comprehensive perspective of the various interventions certifying interdisciplinarity in the field of minimally invasive urologic surgery, which strengthens the curricular framework of the specialty and allows to achieve a significant level of professionalism, evidenced through excellent professional performance(AU)

Mujer y urología: ¿cuál es la situación en España? / Women in urology: What is their current situation in Spain?

Objetivo Analizar la situación actual de las mujeres en la especialidad de Urología en España. Material y métodos Estudio descriptivo a partir de los resultados de una encuesta electrónica remitida entre febrero y abril de 2020 a través de la base de datos del grupo de Residentes y Jóvenes Urólogos (RAEU) de la Asociación Española de Urología (AEU). Se analizaron las características demográficas de la encuesta y los resultados de la misma. Resultados Se obtuvieron 257 respuestas, correspondientes a 210 mujeres (81,71%) y 47 hombres (18,29%) procedentes de 111 hospitales en total. Se obtuvieron diferencias estadísticamente significativas (p<0,001), con una mayor proporción de hombres en todas las categorías, excepto en el grupo de adjuntas y adjuntos jóvenes (29-39años; p=0,789) y en el de residentes mujeres frente a residentes hombres (p=0,814). En los hospitales con unidades subespecializadas se encontró un mayor número de hombres en todas, excepto en la unidad de suelo pélvico, en la que no se observó una diferencia estadísticamente significativa (p=0,06). Respecto a cargos de responsabilidad, en solo 7 de 111 hospitales había jefas de servicio. Conclusiones La presencia de las mujeres en la especialidad de Urología es cada vez mayor, debido mayoritariamente a las generaciones más jóvenes. Sin embargo, el acceso de estas mujeres a puestos de relevancia es anecdótica (AU)

Objective To analyze the current state of women in urology in Spain. Material and methods Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Demographic characteristics of the survey and its results were analyzed. Results In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (P<.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, P=.789), and the group of female residents against male residents (P=.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (P=.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female department chiefs. Conclusions Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal (AU)

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

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

Endoscopic implantation of autologous myoblasts for stress urinary incontinence and evaluation of its efficacy in sphincterotomized rabbits.

INTRODUCTION: Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. MATERIALS AND METHODS: We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up. RESULTS: No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. DISCUSSION AND CONCLUSIONS: The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.

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

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

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

Enuresis: percepción y actitud en la población de nuestro país / Enuresis: Perception and attitude in population of our country

Objetivo Conocer la percepción y la actitud hacia la enuresis por parte de familias y cuidadores con el objetivo de establecer un plan terapéutico racional. Material y métodos Se realizó una encuesta de 25 preguntas a padres y madres mayores de 18años con al menos un hijo de entre 5 y 13años, manteniendo la representatividad nacional en términos de residencia, clase social y edad de los hijos. La recogida de datos se realizó en abril del 2021. Resultados Se obtuvieron datos de 501 encuestas de 626 enviadas, en su mayoría relativos a familias de clase social media de Andalucía, Cataluña y la Comunidad de Madrid. El 47,9% de los encuestados conocían la existencia de la enuresis, aunque únicamente el 23,8% sabían cuál era el término médico. Solo el 16,6% y el 9,6% recordaban que el/la pediatra o el/la enfermero/a, respectivamente, se hubieran referido en algún momento a la misma. Entre los participantes con algún conocimiento, las fuentes de información principales fueron los casos cercanos (36,6%), los medios de comunicación (31,1%) y el pediatra (27,8%). Los padres se preocuparían mucho (35,3%) o bastante (43,1%) ante un caso. Sin embargo, el nivel de conocimiento fue mayor y el grado de preocupación menor entre padres con hijos con enuresis respecto a los que no tenían casos en la familia. Conclusiones Mejorar el conocimiento de los padres sobre la enuresis y cambiar la percepción que tienen de la misma puede resultar de importancia para mejorar su atención y anticipar su resolución (AU)

Objective To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. Material and methods A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. Results Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. Conclusion Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution (AU)

[Enuresis: Perception and attitude in population of our country]. / Enuresis: percepción y actitud en la población de nuestro país.

OBJECTIVE: To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. MATERIAL AND METHODS: A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. RESULTS: Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. CONCLUSION: Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution.

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

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

Tratamiento del síndrome de vejiga hiperactiva mediante estimulación transcutánea bilateral del nervio tibial posterior / Treatment of overactive bladder syndrome by bilateral transcutaneous posterior tibial nerve stimulation

Resumen OBJETIVO: Determinar si la estimulación transcutánea bilateral del nervio tibial posterior disminuye los síntomas de la vejiga hiperactiva y mejora la calidad de vida. MATERIALES Y MÉTODOS: Estudio de cohorte simple, retrospectivo, efectuado en pacientes atendidas en la clínica de Urología Ginecológica del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes en la Ciudad de México, del 8 de octubre de 2021 al 14 de julio de 2022 a quienes se aplicó terapia de electroestimulación bilateral transcutánea del nervio tibial posterior para tratar el síndrome de vejiga hiperactiva.Parámetros de estudio: severidad, calidad de vida y diario miccional en las sesiones 1, 6 y 12. Para la comparación al inicio y al final del tratamiento se utilizó estadística descriptiva y prueba de t pareada; la p < 0.05 se consideró estadísticamente significativa. RESULTADOS: Se estudiaron 25 pacientes: 23 con disminución del puntaje en el cuestionario de calidad de vida King's Health de 24.5 entre las sesiones 1 y 12 (p < 0.001). La disminución del puntaje de severidad de síntomas (Overactive Bladder Symptom Severity [OABSS]) fue de 16.6 entre las sesiones 1 y 12 (p < 0.001). Se observó mejoría significativa en todos los parámetros del diario miccional. CONCLUSIÓN: En esta muestra, la estimulación transcutánea bilateral del nervio tibial posterior disminuyó de manera importante los síntomas de vejiga hiperactiva y mejoró la calidad de vida.

Abstract OBJECTIVE: To determine whether bilateral transcutaneous stimulation of the posterior tibial nerve reduces symptoms of overactive bladder and improves quality of life. MATERIALS AND METHODS: Simple, retrospective, cohort study carried out in patients attended at the gynaecological urology clinic of the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes in Mexico City, from 8 October 2021 to 14 July 2022 to whom bilateral transcutaneous electrostimulation therapy of the posterior tibial nerve was applied to treat overactive bladder syndrome. Study parameters: severity, quality of life and voiding diary in sessions 1, 6 and 12. Descriptive statistics and paired t-test were used for comparison at baseline and at the end of treatment; p < 0.05 was considered statistically significant. RESULTS: Twenty-five patients were studied: 23 with a decrease in King's Health quality of life score of 24.5 between sessions 1 and 12 (p < 0.001). The decrease in symptom severity score (OABSS) was 16.6 between sessions 1 and 12 (p < 0.001). Significant improvement was observed in all voiding diary parameters. CONCLUSION: In this sample, bilateral transcutaneous posterior tibial nerve stimulation significantly decreased overactive bladder symptoms and improved quality of life.

Migración de catéter ureteral doble-J a vena cava inferior, una complicación inusual / Migration of double-J ureteral catheter into the inferior vena cava, an unusual complication

La colocación de catéteres ureterales doble-J es uno de los procedimientos más realizados en Urología, con bajas tasas de complicaciones graves. No obstante, pueden ocurrir y requieren de una identificación y tratamiento precoz. Presentamos el caso de un varón de 73 años intervenido de una prostatectomía radical, al que se le coloca un catéter doble-J por sospecha de lesión ureteral durante la intervención, con inestabilidad hemodinámica en el postoperatorio inmediato secundaria a la migración del catéter a la vena cava inferior

Double-J ureteral catheter placement is one of the most commonly performed procedures in Urology, with low rates of severe complications. Nevertheless, they can occur and require early identification and treatment. We present the case of a 73-year-old man who underwent radical prostatectomy and placement of a double-J catheter due to suspected ureteral injury during the surgery, with hemodynamic instability in the immediate postoperative period secondary to intracaval migration of the catheter.

Evidências tecnológicas para assistência ambulatorial e domiciliar em urologia pediátrica: revisão de escopo / Technological evidence for outpatient and home care in pediatric urology: a scoping review

RESUMO Objetivo mapear as evidências sobre as tecnologias baseadas na internet e sua aplicabilidade no cuidado ambulatorial e domiciliar em urologia pediátrica. Métodos trata-se de revisão de escopo, com buscas conduzidas em seis bases de dados, sem limite de tempo, nos idiomas português, inglês e espanhol. Resultados 2.200 artigos foram obtidos, sendo 19 publicações elegíveis para a amostra final. As tecnologias baseadas na internet mais utilizadas foram telessaúde e telemedicina (47,3%), programas de intervenção online (21,0%) e aplicativos móveis (15,8%), com uma taxa menor de uso de serious game s, mídias sociais e vídeos de micção (5,3%), majoritariamente no contexto domiciliar. Conclusão o mapeamento das evidências tecnológicas na assistência ambulatorial e domiciliar em urologia pediátrica permitiu identificar os tipos de tecnologia e suas aplicações voltadas para o autogerenciamento dos sintomas e autoeficácia, para o monitoramento e acompanhamento do cuidado urológico. Contribuições para a prática: as evidências sintetizadas contribuem para uma prática profissional expandida, qualificada e inovadora junto à população pediátrica com sintomas urinários e intestinais, características relacionadas a uma prática avançada de enfermagem, além de favorecer diagnóstico precoce e maior adesão terapêutica, particularmente por apoiar intervenções personalizadas às necessidades do paciente pediátrico e sua família.

ABSTRACT Objective to map the evidence on web-based technologies and their applicability in outpatient and home care in pediatric urology. Methods this is a scoping review, with searches conducted in six databases, with no time limit, in Portuguese, English, and Spanish. Results 2,200 articles were obtained, with 19 publications eligible for the final sample. The most used web-based technologies were telehealth and telemedicine (47.3%), online intervention programs (21.0%), and mobile apps (15.8%), with a lower rate of use of serious games, social media, and urination videos (5.3%), mostly in the home setting. Conclusion the mapping of technological evidence in outpatient and home care in pediatric urology allowed us to identify the types of technology and their applications focused on self-management of symptoms and self-efficacy, for monitoring and follow-up of urologic care. Contributions to practice: the synthesized evidence contributes to an expanded, qualified, and innovative professional practice with the pediatric population with urinary and bowel symptoms, characteristics related to advanced nursing practice, in addition to favoring early diagnosis and greater therapeutic adherence, particularly by supporting interventions tailored to the needs of the pediatric patient and his family.

Implementación artesanal del sistema VAC en pacientes con Gangrena de Fournier: serie de casos

La fascitis necrosante es una infección de los tejidos blandos profundos que provoca la destrucción progresiva de la fascia muscular y subcutánea. Una de sus presentaciones es la Gangrena de Fournier (GF) para el cual el diagnóstico debe de ser preciso y asociado a desbridamiento quirúrgico precoz y antibioticoterapia de amplio espectro. Si existe retraso del manejo, la repercusión en el pronóstico es negativa. Entre las opciones actuales para el tratamiento destaca una técnica para mejorar la limpieza y granulación del área cruenta mediante el uso del dispositivo tecnológico y el sistema de cierre asistido por vacío (VAC). Describimos el manejo y la técnica de la terapia VAC implementado artesanalmente en una serie de casos de pacientes masculinos con diagnóstico de GF, en respuesta a los escasos recursos económicos de los pacientes que generalmente son afectados en nuestro medio; proponiendo una opción más económica, segura y replicable para nuestro entorno.

Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous . One of its presentations is Fournier's Gangrene (FG) for which the diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC). We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment.

Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study / Análise comparativa entre adenomectomia transvesical aberta e videolaparoscópica no tratamento da hiperplasia prostática benigna em hospital terciário de Curitiba - PR: estudo retrospectivo

ABSTRACT Objective: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. Methods: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. Results: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. Conclusion: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.

RESUMO Objetivo: o objetivo deste estudo foi comparar o resultado das técnicas de prostatectomia transvesical aberta e videolaparoscópica no tratamento de hiperplasia prostática benigna (HPB) em um hospital terciário. Métodos: foram revisados prontuários de pacientes submetidos a adenectomia transvesical devido a HPB entre março de 2019 a março de 2021 no serviço de urologia do Hospital de Clínicas do Paraná (HCPR), sendo incluídos 42 pacientes no grupo prostatectomia transvesical aberta e 22 no grupo videolaparoscópico. Em seguida foi feita a comparação entre as técnicas nos quesitos tempo cirúrgico, sangramento, tempo de internamento, necessidade de terapia intensiva, entre outras, além de desfecho pós-operatório. Resultados: o tempo cirúrgico médio foi menor na técnica aberta em comparação com a técnica videolaparoscópica (141 min vs 274 min). O grupo videolaparoscópico apresentou um tempo médio de internamento menor (3,5 dias vs 6,36 dias). Não houve significância estatística na comparação quanto a necessidade de unidade de terapia intensiva, assim como na avaliação do sangramento pós-operatório. Conclusão: comparativamente, as técnicas demonstraram um desfecho semelhante, com baixa taxa de complicações e resultados satisfatórios para o tratamento da HPB. Sendo a técnica videolaparoscópica uma cirurgia com menor tempo de internamento, porém às custas de um maior tempo cirúrgico. .