J. Gaona, Daniel Romero, P. Robles, Diego Bravo, R. Rueda, J. Ortiz, Daniel Sánchez, César González, Fabio González, Angélica Rueda, Sebastián Ortiz, Carlos Camargo
{"title":"Diagnostic accuracy of uroflowmetry parameters to predict infravesical obstruction","authors":"J. Gaona, Daniel Romero, P. Robles, Diego Bravo, R. Rueda, J. Ortiz, Daniel Sánchez, César González, Fabio González, Angélica Rueda, Sebastián Ortiz, Carlos Camargo","doi":"10.24875/ruc.23000004","DOIUrl":"https://doi.org/10.24875/ruc.23000004","url":null,"abstract":"","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47087215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catalina Barco-Castillo, C. Uribe, Angela Bohórquez, C. Trujillo, Adolfo Serrano
{"title":"Metabolic studies and calculi analysis in urinary lithiasis, how to stop recurrence?","authors":"Catalina Barco-Castillo, C. Uribe, Angela Bohórquez, C. Trujillo, Adolfo Serrano","doi":"10.24875/ruc.22000003","DOIUrl":"https://doi.org/10.24875/ruc.22000003","url":null,"abstract":"","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44178423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trauma renal cerrado de alto grado: el rol de la angioembolización en el manejo secuencial","authors":"María P. Gómez-Bueno, H. García-Perdomo","doi":"10.24875/ruc.23000008","DOIUrl":"https://doi.org/10.24875/ruc.23000008","url":null,"abstract":"","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43187089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Manejo del cáncer de vejiga invasor de músculo con enfoque preservador de órgano: terapia trimodal","authors":"Carlos H. Abonía-Velasco, H. García-Perdomo","doi":"10.24875/ruc.23000007","DOIUrl":"https://doi.org/10.24875/ruc.23000007","url":null,"abstract":"","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41610538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastián Galvis-Acevedo, Daniela Rivas-Escobar, Liliana Arias-Castillo, H. García-Perdomo
La enfermedad cardiovascular aterosclerótica es la primera causa de muerte en todo el mundo, y la principal causa de años de vida perdidos por discapacidad (AVADs) en los adultos. Sus factores de riesgo son muy prevalentes en la población, y su ocurrencia se ha asociado con disfunción sexual tanto en hombres como en mujeres, debido a que comparten un mecanismo fisiopatológico similar en el caso de la disfunción eréctil en los hombres y potencialmente en la disfunción sexual femenina. Además, los trastornos mentales asociados (principalmente ansiedad y depresión) y los efectos adversos de los medicamentos antihipertensivos y antidepresivos también contribuyen a las disfunciones sexuales. Por otro lado, los inhibidores de la fosfodiesterasa 5 (iFDE5s) han demostrado seguridad y beneficios cardiovasculares en los hombres, y en las mujeres hay evidencia creciente de su utilidad en las disfunciones sexuales. En esta revisión, se presentan las implicaciones de la enfermedad cardiovascular aterosclerótica y su tratamiento en la vida sexual de hombres y mujeres, los efectos cardiovasculares de los tratamientos de las disfunciones sexuales, y la consejería a los pacientes.
{"title":"Enfermedad cardiovascular aterosclerótica y sexualidad","authors":"Sebastián Galvis-Acevedo, Daniela Rivas-Escobar, Liliana Arias-Castillo, H. García-Perdomo","doi":"10.1055/s-0042-1746202","DOIUrl":"https://doi.org/10.1055/s-0042-1746202","url":null,"abstract":"La enfermedad cardiovascular aterosclerótica es la primera causa de muerte en todo el mundo, y la principal causa de años de vida perdidos por discapacidad (AVADs) en los adultos. Sus factores de riesgo son muy prevalentes en la población, y su ocurrencia se ha asociado con disfunción sexual tanto en hombres como en mujeres, debido a que comparten un mecanismo fisiopatológico similar en el caso de la disfunción eréctil en los hombres y potencialmente en la disfunción sexual femenina. Además, los trastornos mentales asociados (principalmente ansiedad y depresión) y los efectos adversos de los medicamentos antihipertensivos y antidepresivos también contribuyen a las disfunciones sexuales. Por otro lado, los inhibidores de la fosfodiesterasa 5 (iFDE5s) han demostrado seguridad y beneficios cardiovasculares en los hombres, y en las mujeres hay evidencia creciente de su utilidad en las disfunciones sexuales. En esta revisión, se presentan las implicaciones de la enfermedad cardiovascular aterosclerótica y su tratamiento en la vida sexual de hombres y mujeres, los efectos cardiovasculares de los tratamientos de las disfunciones sexuales, y la consejería a los pacientes.","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49633562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Gaona, Daniel Sánchez, César González, Fabio González, Angélica Rueda, Sebastián Ortiz
Given the limitations of frequentist method for null hypothesis significance testing, different authors recommend alternatives such as Bayesian inference. A poor understanding of both statistical frameworks is common among clinicians. The present is a gentle narrative review of the frequentist and Bayesian methods intended for physicians not familiar with mathematics. The frequentist p-value is the probability of finding a value equal to or higher than that observed in a study, assuming that the null hypothesis (H0) is true. The H0 is rejected or not based on a p threshold of 0.05, and this dichotomous approach does not express the probability that the alternative hypothesis (H1) is true. The Bayesian method calculates the probability of H1 and H0 considering prior odds and the Bayes factor (Bf). Prior odds are the researcher's belief about the probability of H1, and the Bf quantifies how consistent the data is concerning H1 and H0. The Bayesian prediction is not dichotomous but is expressed in continuous scales of the Bf and of the posterior odds. The JASP software enables the performance of both frequentist and Bayesian analyses in a friendly and intuitive way, and its application is displayed at the end of the paper. In conclusion, the frequentist method expresses how consistent the data is with H0 in terms of p-values, with no consideration of the probability of H1. The Bayesian model is a more comprehensive prediction because it quantifies in continuous scales the evidence for H1 versus H0 in terms of the Bf and the posterior odds.
{"title":"Frequentist and Bayesian Hypothesis Testing: An Intuitive Guide for Urologists and Clinicians","authors":"J. Gaona, Daniel Sánchez, César González, Fabio González, Angélica Rueda, Sebastián Ortiz","doi":"10.1055/s-0042-1756171","DOIUrl":"https://doi.org/10.1055/s-0042-1756171","url":null,"abstract":"Given the limitations of frequentist method for null hypothesis significance testing, different authors recommend alternatives such as Bayesian inference. A poor understanding of both statistical frameworks is common among clinicians. The present is a gentle narrative review of the frequentist and Bayesian methods intended for physicians not familiar with mathematics. The frequentist p-value is the probability of finding a value equal to or higher than that observed in a study, assuming that the null hypothesis (H0) is true. The H0 is rejected or not based on a p threshold of 0.05, and this dichotomous approach does not express the probability that the alternative hypothesis (H1) is true. The Bayesian method calculates the probability of H1 and H0 considering prior odds and the Bayes factor (Bf). Prior odds are the researcher's belief about the probability of H1, and the Bf quantifies how consistent the data is concerning H1 and H0. The Bayesian prediction is not dichotomous but is expressed in continuous scales of the Bf and of the posterior odds. The JASP software enables the performance of both frequentist and Bayesian analyses in a friendly and intuitive way, and its application is displayed at the end of the paper. In conclusion, the frequentist method expresses how consistent the data is with H0 in terms of p-values, with no consideration of the probability of H1. The Bayesian model is a more comprehensive prediction because it quantifies in continuous scales the evidence for H1 versus H0 in terms of the Bf and the posterior odds.","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43227392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolás Fernández, Juliana Villanueva Congote, Daniela Varela, J. Prada, I. Zarante, J. Seba, J. Perez, J. Castellanos
Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders. Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery. Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800. Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.
{"title":"Creation of a Pilot Surgical Program for the Comprehensive Management of Patients with Congenital Urological Malformations","authors":"Nicolás Fernández, Juliana Villanueva Congote, Daniela Varela, J. Prada, I. Zarante, J. Seba, J. Perez, J. Castellanos","doi":"10.1055/s-0042-1744465","DOIUrl":"https://doi.org/10.1055/s-0042-1744465","url":null,"abstract":"\u0000 Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders.\u0000 Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery.\u0000 Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800.\u0000 Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48972357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolás Fernández, Daniela Alejandra Varela Herrera, J. Villanueva, Julie Cheng, G. Tasian
Introduction In the pediatric population, the prevalence of stone disease has increased in recent years. We aim to analyze the bibliometric characteristic of available literature on the management of stones in this population. Methods We performed a search for articles published until December 2019 on the Scopus, Google Scholar, PubMed, Embase, and Web of Science databases using the keywords children, lithiasis, and stones. We excluded articles involving patients older than 18 years of age and those with non-urological lithiasis. Then, we performed a bibliometric analysis using the original language, year of publication, impact factor (yearly number of citations), and absolute citation count as variables to calculate the impact index (number of sources adjusted for the time since publication). Results We included 291 articles published between 1940 and December 2019 for analysis. The average number of citations per manuscript was of 15.3 (± 21.9), and the average impact index was of 502 (± 976.4). A total of 4 articles were published before 1970. The evaluation of historical landmarks that could affect citation counts, such as the launch of a journal specialized in pediatric urology (Journal of Pediatric Urology), showed a mean citation count of 23.29 before the first edition, and of 14.96 after (p = 0.0006). The variation on the impact index with the same criteria was of 539.6 before the first edition of the Journal of Pediatric Urology, and of 316.32 after (p = 0.001). The average number of citations before internet access was of 17.9, and, after the internet, of 15.1 (p = 0.17). We also observed a difference in counts regarding languages of publication. Conclusions The proportional academic productivity on pediatric stone disease demonstrates that citation counts do not reflect the true academic impact of subspecialized topics.
介绍 在儿科人群中,近年来结石疾病的患病率有所上升。我们的目的是分析现有文献中关于该人群中石头管理的文献计量特征。方法 我们在Scopus、Google Scholar、PubMed、Embase和Web of Science数据库上搜索了截至2019年12月发表的文章,关键词为儿童、结石和结石。我们排除了涉及18岁以上患者和非泌尿系结石患者的文章。然后,我们使用原始语言、出版年份、影响因素(每年引用次数)和绝对引用次数作为变量进行了文献计量分析,以计算影响指数(根据出版后的时间调整的来源数量)。后果 我们收录了1940年至2019年12月期间发表的291篇文章进行分析。每份手稿的平均引用次数为15.3(± 21.9),平均影响指数为502(± 976.4)。1970年之前共发表了4篇文章。对可能影响引文计数的历史里程碑的评估,如儿科泌尿外科杂志(journal of pediatric urology)的推出,显示第一版前的平均引文计数为23.29,第一版后的平均引文数为14.96(p = 0.0006)。在《儿科泌尿学杂志》第一版出版前,采用相同标准的影响指数变化为539.6,出版后为316.32(p = 0.001)。上网前的平均引用次数为17.9次,上网后为15.1次(p = 0.17)。我们还观察到出版语言的计数存在差异。结论 儿科结石病的学术生产力比例表明,引文数量并不能反映亚专业主题的真正学术影响。
{"title":"Publication Trends in Pediatric Stone Disease: A Bibliometric Analysis","authors":"Nicolás Fernández, Daniela Alejandra Varela Herrera, J. Villanueva, Julie Cheng, G. Tasian","doi":"10.1055/s-0042-1748870","DOIUrl":"https://doi.org/10.1055/s-0042-1748870","url":null,"abstract":"\u0000 Introduction In the pediatric population, the prevalence of stone disease has increased in recent years. We aim to analyze the bibliometric characteristic of available literature on the management of stones in this population.\u0000 Methods We performed a search for articles published until December 2019 on the Scopus, Google Scholar, PubMed, Embase, and Web of Science databases using the keywords children, lithiasis, and stones. We excluded articles involving patients older than 18 years of age and those with non-urological lithiasis. Then, we performed a bibliometric analysis using the original language, year of publication, impact factor (yearly number of citations), and absolute citation count as variables to calculate the impact index (number of sources adjusted for the time since publication).\u0000 Results We included 291 articles published between 1940 and December 2019 for analysis. The average number of citations per manuscript was of 15.3 (± 21.9), and the average impact index was of 502 (± 976.4). A total of 4 articles were published before 1970. The evaluation of historical landmarks that could affect citation counts, such as the launch of a journal specialized in pediatric urology (Journal of Pediatric Urology), showed a mean citation count of 23.29 before the first edition, and of 14.96 after (p = 0.0006). The variation on the impact index with the same criteria was of 539.6 before the first edition of the Journal of Pediatric Urology, and of 316.32 after (p = 0.001). The average number of citations before internet access was of 17.9, and, after the internet, of 15.1 (p = 0.17). We also observed a difference in counts regarding languages of publication.\u0000 Conclusions The proportional academic productivity on pediatric stone disease demonstrates that citation counts do not reflect the true academic impact of subspecialized topics.","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48706119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
La prostatectomía radical (PR) es uno de los pilares en el manejo del cáncer próstata. Esta cirugía constituye un reto para el urólogo, quien debe encontrar un balance entre el riesgo de extensión extraprostática y el grado de preservación del tejido neural. A pesar del avance en técnicas quirúrgicas, la incontinencia urinaria y disfunción eréctil (DE) post-prostatectomía continúan impactando considerablemente la calidad de vida de los pacientes. Por lo anterior, un abordaje transdisciplinario desde el momento del diagnóstico es esencial para mejorar los desenlaces funcionales y oncológicos. En el escenario preoperatorio, comprender el contexto cultural y psicosocial del paciente permite establecer expectativas frente a la cirugía. Este es un campo aún por explorar en el ámbito colombiano, que requiere identificar disparidades y estrategias para disminuir las mismas. El desconocimiento de los temores del paciente, especialmente los relacionados con su percepción de masculinidad, podría constituir una de las principales razones de insatisfacción después del tratamiento quirúrgico.1,2 Del mismo modo, la función sexual de la pareja y la calidad de la relación conyugal juegan un papel esencial en la recuperación de la función eréctil (FE). Existe evidencia de mayor adherencia a programas de rehabilitación cuando la salud sexual de la pareja es evaluada y optimizada paralelamente.3 Sin embargo, lo anterior es comúnmente ignorado en la práctica clínica, por lo cual explorar la integración de terapias cognitivo conductuales que involucren a ambos es importante en el proceso perioperatorio. El concepto de pre-habilitación debe hacer parte de los programas destinados al manejo de cáncer de próstata con el fin de optimizar el estado de salud y FE basal del paciente. La enfermedad cardiovascular, el síndrome metabólico y el tabaquismo, así como el sedentarismo y las alteraciones en el ciclo circadiano deberían ser identificados y manejados tempranamente.4–6 Asimismo, aunque la evidencia es controversial y no existe una guía validada con respecto al uso de inhibidores de la fosfodiesterasa5 antes de la cirugía, aquellos pacientes que reciben una intervenciónmultimodal parecen obtener mejores resultados.7 La combinación de múltiples variables clínicas, histológicas e imagenológicas para la predicción de enfermedad no órgano confinada permite una planeación quirúrgica meticulosa. En nuestra institución empleamos el nomograma descrito por Martini et al.8 para la predicción ‘lado-específica’ de extensión extracapsular e invasión de vesículas seminales, lo cual nos permite determinar el grado de preservación de los nervios según el sistema propuesto por Tewari et al.9 Recientemente hemos integrado el microultrasonido transrectal como parte del protocolo de evaluación preoperatoria, obteniendo resultados prometedores en la predicción de extensión extraprostática. En cuanto a la técnica quirúrgica, es clara la complejidad de los nervios peri-prostáticos, los cuales
{"title":"¿Cómo mejorar la función eréctil post-prostatectomía radical?","authors":"Adriana M. Pedraza","doi":"10.1055/s-0042-1757160","DOIUrl":"https://doi.org/10.1055/s-0042-1757160","url":null,"abstract":"La prostatectomía radical (PR) es uno de los pilares en el manejo del cáncer próstata. Esta cirugía constituye un reto para el urólogo, quien debe encontrar un balance entre el riesgo de extensión extraprostática y el grado de preservación del tejido neural. A pesar del avance en técnicas quirúrgicas, la incontinencia urinaria y disfunción eréctil (DE) post-prostatectomía continúan impactando considerablemente la calidad de vida de los pacientes. Por lo anterior, un abordaje transdisciplinario desde el momento del diagnóstico es esencial para mejorar los desenlaces funcionales y oncológicos. En el escenario preoperatorio, comprender el contexto cultural y psicosocial del paciente permite establecer expectativas frente a la cirugía. Este es un campo aún por explorar en el ámbito colombiano, que requiere identificar disparidades y estrategias para disminuir las mismas. El desconocimiento de los temores del paciente, especialmente los relacionados con su percepción de masculinidad, podría constituir una de las principales razones de insatisfacción después del tratamiento quirúrgico.1,2 Del mismo modo, la función sexual de la pareja y la calidad de la relación conyugal juegan un papel esencial en la recuperación de la función eréctil (FE). Existe evidencia de mayor adherencia a programas de rehabilitación cuando la salud sexual de la pareja es evaluada y optimizada paralelamente.3 Sin embargo, lo anterior es comúnmente ignorado en la práctica clínica, por lo cual explorar la integración de terapias cognitivo conductuales que involucren a ambos es importante en el proceso perioperatorio. El concepto de pre-habilitación debe hacer parte de los programas destinados al manejo de cáncer de próstata con el fin de optimizar el estado de salud y FE basal del paciente. La enfermedad cardiovascular, el síndrome metabólico y el tabaquismo, así como el sedentarismo y las alteraciones en el ciclo circadiano deberían ser identificados y manejados tempranamente.4–6 Asimismo, aunque la evidencia es controversial y no existe una guía validada con respecto al uso de inhibidores de la fosfodiesterasa5 antes de la cirugía, aquellos pacientes que reciben una intervenciónmultimodal parecen obtener mejores resultados.7 La combinación de múltiples variables clínicas, histológicas e imagenológicas para la predicción de enfermedad no órgano confinada permite una planeación quirúrgica meticulosa. En nuestra institución empleamos el nomograma descrito por Martini et al.8 para la predicción ‘lado-específica’ de extensión extracapsular e invasión de vesículas seminales, lo cual nos permite determinar el grado de preservación de los nervios según el sistema propuesto por Tewari et al.9 Recientemente hemos integrado el microultrasonido transrectal como parte del protocolo de evaluación preoperatoria, obteniendo resultados prometedores en la predicción de extensión extraprostática. En cuanto a la técnica quirúrgica, es clara la complejidad de los nervios peri-prostáticos, los cuales","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47611856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}