Actas urologicas espanolas最新文献

Objectives: To evaluate health-related quality of life (HRQOL) six years post-radical cystectomy in patients with muscle-invasive bladder cancer, comparing orthotopic ileal neobladder (ONB) and ileal conduit (IC). Therefore, the study aims to analyze the under-investigated long-term impact of standard bladder cancer treatments on HRQOL and provide insights into the HRQOL differences associated with these two common urinary diversion methods.

Patients and methods: This prospective study included 39 patients with urothelial carcinoma treated with ONB or IC at our center between 03/2013 and 01/2023. Patients with variant histology, metastasis, neoadjuvant chemotherapy, or benign indications for cystectomy were excluded. HRQOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire preoperatively, at four and six years postoperatively. Statistical analyses included Chi-square tests, T-tests, and logistic regression models.

Results: Of the patients, 64% (25/39) underwent ONB, and 76.9% (30/39) were male, with an average age of 69 years. No significant differences in overall good HRQOL (GHS > 70) were observed between ONB and IC at six years (IC: 60 ± 22; ONB: 69 ± 23, p = 0.2). Patients with IC reported higher insomnia at both follow-ups (4 years: p = 0.01; 6 years: p = 0.03). Emotional function remained stable in ONB patients but declined in IC patients from the fourth to sixth years (p = 0.04).

Conclusion: Long-term HRQOL did not significantly differ between ONB and IC up to six years post-radical cystectomy. Both urinary diversion methods can be offered to patients, with tailored discussions in terms of HRQOL.

Introduction and objective: Radical prostatectomy has a great impact on urinary continence, although it is a multifactorial aspect. The aim of the study was to evaluate the effect of guided Pelvic Floor Exercises (PFE) versus written information prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence, and their effect on patients' quality of life.

Material and method: 62 patients were randomized to an experimental (physiotherapist-guided exercises) or control (written information) group. The primary outcome was incontinence rate (measured by pad test). Secondary outcomes were incontinence severity, quality of life (measured by the 36-Item Short Form Survey Instrument (SF-36) and the King's Health Questionnaire (KHQ)), voiding dynamics, correlation between incontinence and quality of life, and other incontinence-related factors.

Results: We found no differences in the incontinence rate between groups in the months of follow-up (82.61% vs. 84.62%, month 1; 61.54% vs. 75.86%, month 3; 50% vs. 53.33%, month 6; 30.77% vs. 40%, month 12) nor in the severity of incontinence between groups. There were significant differences in the quality of life related to "emotional problems" and "personal relationships", in favor of the control group. We found correlations between incontinence severity and age, severity and quality of life, urgency/frequency and quality of life.

Conclusions: Guided exercises prior to RRP do not seem to offer benefits over written information in either the rate or severity of incontinence. Urinary incontinence correlates with age and quality of life. Quality of life correlates with urgency and voiding frequency.

Objective: The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate (HoLEP) in 125 consecutive cases.

Materials and methods: Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by HoLEP were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test.

Results: Surgical time decreased progressively: 92 min. (Q1), 65 min. (Q2), 54 min. (Q3), 45 min. (Q4) and 50 min. (Q5) (p < 0.001). Enucleation rate gradually increased: 1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min (Q4) and 2.74 g/min (Q5) (p < 0.001). There were no differences in enucleated weight (Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g) (p = 0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p > 0.05). Time to continence recovery was similar in quintiles 1-4 (23, 27, 21, 20 days) and shorter in quintile 5 (3.5 days) (p < 0.001).

Conclusion: The initiation of a HoLEP program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.

Introduction: Urinary tract infections (UTIs) remain a major cause of morbidity in otherwise healthy women. It is estimated at least 50% of women will have at least 1 UTI in their lifetime. Current guidelines recommend the use of antibiotics (ABs) for treatment, constituting the 2nd most common reason for their prescribing. However, antibiotic resistance remains a worrying problem, therefore it is almost imperative to find alternatives for UTIs. One of the most suggested alternatives are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Some clinical trials have shown that these are similar to ABs in resolving urinary symptoms OBJETIVOS: evaluar la eficacia de los AINE en el tratamiento de las ITU no complicadas en mujeres sanas no embarazadas, y demostrar su no inferioridad frente al tratamiento antibiótico. MéTODOS: Esta revisión basada en la evidencia incluyó artículos publicados entre enero de 2010 y diciembre de 2021 en bases de datos médicas, utilizando las palabras clave MeSH: «NSAIDs», «UTI» y «Treatment». Se utilizó la escala Strength of Recommendation Taxonomy (SORT) para clasificar el nivel de la evidencia.

Resultados: De los 8 artículos seleccionados, la mayoría concluyeron que los AB son más eficaces para el tratamiento de las ITU, ya que el cuadro clínico se resolvió con mayor rapidez. Sin embargo, según los artículos, los AINE también demostraron ser eficaces. Por otra parte, se encontró que el tratamiento con AINE no presenta un riesgo mayor de complicaciones.

Conclusiones: Los AB siguen siendo el tratamiento de elección para las ITU, y aún no hay datos suficientes que apoyen el uso de AINE. Sin embargo, se necesitan más estudios para evaluar su eficacia en el manejo de los síntomas de las ITU, pues podrían suponer una alternativa para reducir la prescripción de AB.