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Curtis Nickel J, Foley S, Yang B, Casanovas M, Caballero R, Diez-Rivero CM, Lorenzo-Gómez MF. Reducing Recurrent Urinary Tract Infections in Women with MV140 Impacts Personal Burden of Disease: Secondary Analyses of a Randomized Placebo-controlled Efficacy Study. EUR UROL SUPPL 2024; 63:96-103. [PMID: 38585593 PMCID: PMC10995795 DOI: 10.1016/j.euros.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background Recurrent urinary tract infection (rUTI) remains a major health burden for women. A randomized, double-blind, placebo-controlled trial (RCT; NCT02543827) reported that female patients with rUTI receiving a sublingual vaccine, MV140, had a reduction in rUTI and increase in UTI-free rate compared with placebo. Objective To determine the impact of MV140 on the personal burden of disease in women with rUTI using secondary endpoint data from the pivotal RCT evaluating MV140. Design setting and participants In the primary RCT, female patients with rUTI enrolled in Spain and UK (from October 2015 to April 2019) were randomized to placebo (6 mo) or MV140 (3 or 6 mo), and followed for 12 mo. Individuals analyzed in this secondary analysis included those in the placebo and 3-mo (recommended dose) groups. Intervention A polybacterial sublingual vaccine, MV140 (four inactivated whole-cell bacteria-Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis), or placebo. Outcome measurements and statistical analysis Symptom severity scoring, antibiotic use, safety, and multiple aspects of quality of life (QoL; Short-Form Questionnaire [SF-36]) were assessed. Results and limitations Compared with the placebo group (n = 76), the 3-mo vaccinated group (n = 74) experienced fewer overall UTI symptoms (mean symptom score 102.2 ± 222.9 vs 194.2 ± 178.8; p = 0.0002), fewer days on antibiotics (12.4 ± 17.7 vs 28.7 ± 25.2; p = 0.0001), and improved total, general, and physical SF-36 QoL improvement (differences in means for total SF-36 score 15.7; 95% confidence interval [CI] 8.80, 22.64; p < 0.0001), with only social function QoL showing no impact (4.07; 95% CI -4.93, 13.08; p = 0.3744). Conclusions Three months of MV140 is associated with a reduction of the personal burden of UTI by reducing overall UTI symptoms and antibiotic use, improving QoL in women with rUTI. Patient summary Three months of MV140 vaccine, which has previously been shown to reduce the risk of urinary tract infection safely, is associated with a reduction in the personal burden of disease.
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Affiliation(s)
| | | | - Bob Yang
- Royal Berkshire Hospital, Reading, UK
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Noya-Mourullo A, Martín-Parada A, Palacios-Hernández A, Eguiluz-Lumbreras P, Heredero-Zorzo Ó, García-Gómez F, Álvarez-Ossorio-Fernández JL, Álvarez-Ossorio-Rodal A, Márquez-Sánchez MT, Flores-Fraile J, Fraile-Gómez P, Padilla-Fernández BY, Lorenzo-Gómez MF. Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs. J Pers Med 2024; 14:408. [PMID: 38673035 PMCID: PMC11051259 DOI: 10.3390/jpm14040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. AIMS To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. METHODS Retrospective observational multicentre study. SAMPLE Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). RESULTS Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50-42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. CONCLUSIONS Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.
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Affiliation(s)
- Andrea Noya-Mourullo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Alejandro Martín-Parada
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Alberto Palacios-Hernández
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Pablo Eguiluz-Lumbreras
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Óscar Heredero-Zorzo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Francisco García-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | | | | | | | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Pilar Fraile-Gómez
- Nephrology Department, University Hospital of Salamanca, 37007 Salamanca, Spain;
| | | | - María-Fernanda Lorenzo-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
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Chantada-Tirado P, Chantada-Abal V, Cózar-Ortiz JD, Chantada-Tirado C, Cózar-Olmo JM, Esteban-Fuertes M, Alvarez-Ossorio-Rodal A, Flores-Fraile J, Márquez-Sánchez MT, Padilla-Fernández BY, Lorenzo-Gómez MF. Relationship between Mental Disorders, Smoking or Alcoholism and Benign Prostate Disease. Clin Pract 2024; 14:250-264. [PMID: 38391406 PMCID: PMC10888384 DOI: 10.3390/clinpract14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. AIMS To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. METHODOLOGY A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP-men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU-men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. VARIABLES age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student's t-test, Chi2, multivariate analysis. RESULTS There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). CONCLUSIONS Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.
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Affiliation(s)
| | | | - José-David Cózar-Ortiz
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain
- Psychiatry Department, Gómez Ulla Defense Central University Hospital, 28047 Madrid, Spain
| | | | | | | | | | | | | | | | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain
- Urology Service, University Hospital of Salamanca, 37007 Salamanca, Spain
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Ortíz de Urbina Comerón P, Zubizarreta-Macho Á, Lobo Galindo AB, Montiel-Company JM, Lorenzo-Gómez MF, Flores Fraile J. Relationship between Prostate Inflammation and Periodontal Disease-A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6070. [PMID: 37763009 PMCID: PMC10531617 DOI: 10.3390/jcm12186070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to analyze the association between periodontal disease and prostate inflammation with a null hypothesis stating that periodontal disease does not increase the incidence of prostate inflammation. MATERIALS AND METHODS A systematic literature review and meta-analysis of longitudinal observational cohort and case-control studies that evaluated the odds ratio or hazard ratio and confidence interval was undertaken based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (2020). A total of four databases were consulted in the literature search: PubMed-Medline, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, seven articles were selected for the qualitative and quantitative analyses. RESULTS Four observational cohort studies and three observational cohort case-control studies were included in the meta-analysis. The four observational cohort studies were combined using the random effects model to estimate a hazard ratio of 1.32 with a confidence interval of 95% between 0.87 and 1.77. The meta-analysis presented high heterogeneity (Q test = 56.1; p value < 0.001; I2 = 94.9%). Moreover, the three observational case-control studies were combined using the random effects model to estimate an odds ratio of 1.62 with a confidence interval of 95% between 1.41 and 1.84. The meta-analysis presented high heterogeneity (Q test = 1.07; p value = 0.782; I2 = 0%). CONCLUSIONS The incidence of periodontal disease does not increase the risk of the incidence of prostate inflammation.
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Affiliation(s)
- Pablo Ortíz de Urbina Comerón
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Ana Belén Lobo Galindo
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
- Servicio de Urología del Hospital, Universitario de Salamanca, 37007 Salamanca, Spain
| | - Javier Flores Fraile
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (P.O.d.U.C.); (M.-F.L.-G.); (J.F.F.)
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Noya-Mourullo A, Herrero-Polo M, Heredero-Zorzo O, García-Gómez F, Urrea-Serna C, Marquez-Sanchez MT, Flores-Fraile J, Padilla-Fernandez BY, Lorenzo-Gómez MF. Four vertex technique for correcting urethral prolapse: technique description and cohort study. Front Surg 2023; 10:1149729. [PMID: 37383386 PMCID: PMC10293759 DOI: 10.3389/fsurg.2023.1149729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction/Objectives This study aims to describe the procedure and effectiveness of the four-vertex technique for correcting urethral prolapse in women. Methods and Materials includes a retrospective case series of 17 patients who underwent surgery for urethral prolapse. Two study groups were distinguished based on the presence or absence of pelvic heaviness symptoms. The variables were analyzed, including age, BMI, concomitant diseases, obstetric and gynecological history, time from diagnosis to surgery, and outcomes of treatment. Results All patients were postmenopausal, with a mean age at the time of the intervention of 70.41 years, with no differences between groups. Mean BMI was 23.67 kg/m2, higher in the group with a sensation of vaginal heaviness (p = 0.027). Mean time elapsed between diagnosis and operation was 231.58 days, with no differences between groups. Mean childbirth count was 2.29. The most frequent causes for consultation were urethrorrhagia (33.33%) and a bulging sensation (33.33%). After the intervention, 14 patients (82.35%) were asymptomatic, two (11.76%) had dysuria, and one (5.88%) had urinary urgency. Ten patients had pre-surgical urinary incontinence, which was resolved in nine patients. 17.46% subsequently presented pelvic organ prolapse. In three women there was secondary impairment of sexual activity. Conclusion The four-vertex technique was effective in resolving symptoms in most patients. However, some patients experienced dysuria, urinary urgency, and pelvic organ prolapse after surgery. Urinary incontinence improved in most patients, but a few required additional treatments with suburethral tape. The study also identified associations between variables and the presence of cystocele, consultation for a bulging sensation, and bleeding from urethral prolapse. Overall, this study sheds light on the challenges and outcomes of surgical treatment for urethral prolapse and provides valuable insights for future research in this area.
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Affiliation(s)
| | - Manuel Herrero-Polo
- Urology Department of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | - Carmen Urrea-Serna
- Urology Department of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | | | - María-Fernanda Lorenzo-Gómez
- Urology Department of the University Hospital of Salamanca, Salamanca, Spain
- Department of Surgery of the University of Salamanca, Salamanca, Spain
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Cózar-Ortiz JD, Cózar-Olmo JM, Álvarez-Ossorio-Fernández JL, Esteban-Fuertes M, Chantada-Abal V, Valverde-Martínez LS, Márquez-Sánchez MT, Padilla-Fernández BY, Lorenzo-Gómez MF. The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy. Actas Urol Esp 2022; 46:646-652. [PMID: 36273759 DOI: 10.1016/j.acuroe.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. MATERIAL AND METHODS Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. RESULTS 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. CONCLUSIONS Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.
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Affiliation(s)
- J D Cózar-Ortiz
- Servicio de Psiquiatría, Hospital Universitario Gómez Ulla, Madrid, Spain
| | - J M Cózar-Olmo
- Departamento de Cirugía, Universidad de Granada, Granada, Spain
| | | | - M Esteban-Fuertes
- Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - M F Lorenzo-Gómez
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, Spain; Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Lorenzo-Gómez MF, Foley S, Nickel JC, García-Cenador MB, Padilla-Fernández BY, González-Casado I, Martínez-Huélamo M, Yang B, Blick C, Ferreira F, Caballero R, Saz-Leal P, Casanovas M. Sublingual MV140 for Prevention of Recurrent Urinary Tract Infections. NEJM Evid 2022; 1:EVIDoa2100018. [PMID: 38319200 DOI: 10.1056/evidoa2100018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Sublingual MV140 for Prevention of Recurrent UTIThis randomized placebo-controlled trial tested MV140, a sublingual preparation of whole-cell inactivated bacteria, in women with recurrent urinary tract infection (UTI). MV140 administered sublingually for either 3 or 6 months decreased UTI incidence and prevented recurrence for up to 1 year compared with placebo, without serious adverse events.
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Affiliation(s)
| | - Stephen Foley
- Department of Urology, Royal Berkshire Hospital, Reading, United Kingdom
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | | | | | | | - Bob Yang
- Department of Urology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Christopher Blick
- Department of Urology, Royal Berkshire Hospital, Reading, United Kingdom
| | | | | | - Paula Saz-Leal
- Medical Department, Inmunotek S.L., Alcalá de Henares, Spain
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Márquez-Sánchez GA, Padilla-Fernández BY, Perán-Teruel M, Navalón-Verdejo P, Valverde-Martínez S, Márquez-Sánchez MT, Flores-Fraile J, Lorenzo-Gómez MF. Remeex ® System Effectiveness in Male Patients with Stress Urinary Incontinence. J Clin Med 2021; 10:jcm10102121. [PMID: 34068891 PMCID: PMC8156339 DOI: 10.3390/jcm10102121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.
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Affiliation(s)
| | | | - Miguel Perán-Teruel
- Department of Urology, University Hospital Arnau de Villanova, 46015 Valencia, Spain;
| | - Pedro Navalón-Verdejo
- Department of Urology, University Hospital Casa de Salud, Catholic University of Valencia, 46021 Valencia, Spain;
| | - Sebastián Valverde-Martínez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05004 Ávila, Spain
| | - Magaly-Teresa Márquez-Sánchez
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Correspondence:
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology University Hospital of Salamanca, 37007 Salamanca, Spain
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Borrego-Jimenez PS, Flores-Fraile J, Padilla-Fernández BY, Valverde-Martinez S, Gómez-Prieto A, Márquez-Sánchez MT, Mirón-Canelo JA, Lorenzo-Gómez MF. Improvement in Quality of Life with Pelvic Floor Muscle Training and Biofeedback in Patients with Painful Bladder Syndrome/Interstitial Cystitis. J Clin Med 2021; 10:jcm10040862. [PMID: 33669734 PMCID: PMC7922867 DOI: 10.3390/jcm10040862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To prove the benefits of pelvic floor muscle training with biofeedback (BFB) as a complementary treatment in women with bladder pain syndrome/interstitial cystitis (BPS/IC). Methods: Prospective, randomized study in 123 women with BPS/IC. Groups: BFB+ (n = 48): women with oral drug treatment (perphenazine and amitriptyline) plus intravesical instillations (sodium hyaluronate) plus pelvic floor muscle training with BFB; BFB−: (n = 75): women with oral drug treatment plus intravesical instillations. Variables: age, body mass index (BMI), time of follow-up, length of disease, time free of disease, diseases and health conditions concomitant, and responses to the SF-36 health-related quality of life questionnaire at the first consultation (SF-36 pre-treatment), and at the end of the study (SF-36 post-treatment). The treatment was considered successful when the SF-36 score reached values equal to or greater than 80 points or when the initial value increased by 30 or more points. Results: Mean age was 51.62 years old (23–82). BMI was higher in BFB−. The mean length of BPS/IC condition was 4.92 years (1–20), shorter in BFB+ than in BFB−. Mean SF-36 score pre-treatment was 45.92 points (40–58), lower in BFB+ than in BFB−. Post-treatment SF-36 score was higher than pre-treatment SF-36 score both in BFB+ and BFB−. SF-36 values were higher in BFB+ compared to BFB− over the follow-up. Conclusions: BFB improves quality of life in women with BPS/IC as adjunct therapy to combined oral and intravesical treatment.
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Affiliation(s)
- Pedro-Santiago Borrego-Jimenez
- Physiotherapy Department of Institute of Applied Technology, Abu Dhabi 3798, United Arab Emirates;
- Department of Health Sciences and Education, University UDIMA, 28400 Madrid, Spain
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (S.V.-M.); (M.-F.L.-G.)
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (S.V.-M.); (M.-F.L.-G.)
- Correspondence:
| | | | - Sebastián Valverde-Martinez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.T.M.-S.); (J.-A.M.-C.)
- Department of Urology, University Hospital of Ávila, 05004 Ávila, Spain
| | - Agustín Gómez-Prieto
- Department of Emergency, University Hospital of Salamanca, 37007 Salamanca, Spain;
| | - Magaly Teresa Márquez-Sánchez
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.T.M.-S.); (J.-A.M.-C.)
| | - José-Antonio Mirón-Canelo
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.T.M.-S.); (J.-A.M.-C.)
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007 Salamanca, Spain
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.T.M.-S.); (J.-A.M.-C.)
- Department of Urology, University Hospital of Salamanca, 37007 Salamanca, Spain
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Lorenzo-Gómez MF, Flores-Fraile MC, Márquez-Sánchez M, Flores-Fraile J, González-Casado I, Padilla-Fernández B, Valverde-Martínez S, Hernández Sánchez T, Muller-Arteaga C, García-Cenador MB. Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections. Ther Adv Urol 2020; 12:1756287220974133. [PMID: 33335564 PMCID: PMC7724260 DOI: 10.1177/1756287220974133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/25/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To characterize the impact on kidney injury of recurrent urinary tract
infections (RUTI) in the frail elderly. Methods: Prospective observational study in 200 frail elderly subjects for 1 year.
Groups: GA (n = 100): subjects without RUTI, GB
(n = 100): subjects with RUTI. Variables: age,
concomitant diseases, glomerular filtration rate (GFR), urine neutrophil
gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end
(NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning
(NAG-1) and the end (NAG-2) of the study, urine transforming growth
factor-beta 1 (TGFβ-1). Descriptive statistics, Mann–Whitney test,
Chi-squared test, Fisher’s exact test, and multivariate analysis were
used. Results: Mean age was 84.33 (65–99) years old, with no difference between GA and GB.
Mean NGAL-1 was 1.29 ng/ml (0.04–8). There was lower in GA than in GB. Mean
NGAL-2 was 1.41 ng/ml (0.02–9.22). NGAL-2 was lower in GA than in GB. Mean
NAG-1 was 0.38 UU.II/ml (0.01–2.63. NAG-1 in GA was lower than in GB. Mean
NAG-2 was 0.44 UU.II/ml (0–3.41). NAG-2 was lower in GA compared with GB.
Mean TGFβ-1 was 23.43 pg/ml (0.02–103.76). TGFβ-1 was lower in GA than GB.
There were no differences in the presence of secondary diagnoses between GA
and GB. NAG-2 and NGAL-1 were the most determining factors of renal
function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1,
followed by NAG-2. Conclusion: Frail elderly with RUTI have higher urinary levels of renal injury markers,
specifically NGAL, NAG, and TGFβ-1, chronically in periods between urinary
tract infection (UTI). Urinary markers of renal injury, specifically NGAL,
NAG, and TGFβ-1, identify early deterioration of renal function, compared
with serum creatinine, or albuminuria, in frail elderly with recurrent
urinary infections.
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Affiliation(s)
- María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, Salamanca, Spain Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain Urology Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | - Magaly Márquez-Sánchez
- Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, Alfonso X el sabio Campus Miguel de Unamuno, Salamanca, 37008, Spain
| | - Ignacio González-Casado
- Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain
| | | | - Sebastián Valverde-Martínez
- Department of Surgery, University of Salamanca, Salamanca, Spain Multidisciplinary Renal Research Group) of the Institute for Biomedical Research of Salamanca (IBSAL), Spain Department of Urology of University Hospital of Avila, Spain
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Cisneros-Pérez J, Yusta-Martín G, Sánchez-Conde MP, Padilla-Fernandez BY, Valverde-Martínez LS, Martin-Hernandez M, Prieto Nogal S, Flores-Fraile J, Esteban-Fuertes M, García-Cenador MB, Lorenzo-Gómez MF. The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape. J Clin Med 2020; 9:jcm9082607. [PMID: 32796713 PMCID: PMC7464496 DOI: 10.3390/jcm9082607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence (SUI) has an incidence of 15-80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. AIMS To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. MATERIALS AND METHODS A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student's t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p < 0.05. RESULTS Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. CONCLUSIONS Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.
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Affiliation(s)
- Juan Cisneros-Pérez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
| | - Gemma Yusta-Martín
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Department of Anesthesiology of University Hospital of Salamanca, 37007 Salamanca, Spain
| | - María-Pilar Sánchez-Conde
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Department of Anesthesiology of University Hospital of Salamanca, 37007 Salamanca, Spain
| | | | - Lauro-Sebastian Valverde-Martínez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Mario Martin-Hernandez
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Sara Prieto Nogal
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Correspondence:
| | - Manuel Esteban-Fuertes
- Department of Urology of National University Hospital of Paraplegic, 45004 Toledo, Spain;
| | - María-Begoña García-Cenador
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology of University Hospital of Salamanca, 37007 Salamanca, Spain
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Padilla-Fernández B, García-Cenador MB, Rodríguez-Marcos P, López-Marcos JF, Antúnez-Plaza P, Silva-Abuín JM, López-Montañés D, García-Criado FJ, Lorenzo-Gómez MF. Experimental murine model of renal cancer. Actas Urol Esp 2017; 41:445-450. [PMID: 28162771 DOI: 10.1016/j.acuro.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to determine the reproducibility in a murine model of renal tumours of various histological strains that could be useful for investigating the response to target drugs. MATERIAL AND METHODS Development and analysis of the "in vivo" model: tumour xenograft of renal cell carcinomas with Balb/c nude athymic mice. Nontumourous human renal tissue was implanted in the interscapular region of 5 mice, chromophobe renal cell carcinoma was implanted in 5 mice (which, after checking its growth, was prepared for implantation in another 10 mice) and Fuhrman grade 2 clear cell renal cell carcinoma (CCRCC) was implanted in 5 mice (which was also subsequently implanted in 10 mice). We monitored the tumour size, onset of metastases and increase in size and number of tumours. When the size had reached a point greater than or equal to locally advanced or metastatic carcinoma, the animals were euthanised for a pathological and immunohistochemical study and a second phase of implantation. RESULTS The subcutaneous xenograft of the healthy tissue did not grow. The animals were euthanised at 6 months and no renal tissue was found. The chromophobe renal cell carcinoma cells grew in the initial phase (100%); however, in the second phase, we observed a chronic lymphomonocyte inflammatory reaction and a foreign body reaction. The CCRCC grew at 5-8 months both in the first and second phase (100%), maintaining the tumour type and grade. CONCLUSIONS The model with athymic Balb/c nude mice is useful for reproducing CCRCC, with the same histological characteristics and aggressiveness as native human tumours, promoting the development of the second experimental phase.
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Affiliation(s)
| | | | | | - J F López-Marcos
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, España
| | - P Antúnez-Plaza
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | | | - D López-Montañés
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, España
| | - F J García-Criado
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, España
| | - M F Lorenzo-Gómez
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, España.
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Sánchez-Sánchez FJ, Pérez-Esteban MB, Padilla-Fernández B, Lorenzo-Gómez MF. Spanish jurisprudence on complaints related to pelvic floor surgery. Actas Urol Esp 2015; 39:463-4. [PMID: 25888207 DOI: 10.1016/j.acuro.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- F J Sánchez-Sánchez
- Asesoría Jurídica del Colegio Oficial de Médicos de Salamanca, Salamanca, España
| | - M B Pérez-Esteban
- Asesoría Jurídica del Colegio Oficial de Médicos de Salamanca, Salamanca, España
| | - B Padilla-Fernández
- Servicio de Urología, Complejo Hospitalario Universitario de Canarias, Tenerife, España
| | - M F Lorenzo-Gómez
- Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
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Lorenzo-Gómez MF, Padilla-Fernández B, Antúnez-Plaza P, Gracía-Criado FJ, Mirón-Canelo JA, Silva Abuín JM. Clinical profile and epidemiological changes of clear cell renal carcinoma during 12 years in our health area. ARCH ESP UROL 2012; 65:823-829. [PMID: 23154606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate changes in the epidemiology and clinical profile of patients diagnosed with renal clear cell carcinoma in a community health area over 12 years. METHODS Retrospective analysis of epidemiological characteristics and clinical profile of patients diagnosed with renal clear cell carcinoma in a health area composed of a population of 353.619 inhabitants from January 1999 to December 2010. Descriptive statistical and multivariate analysis, Fisher exact test and Chi-Square were utilized. p<0.05 was accepted as significant. RESULTS 349 diagnoses of renal mass were reported; 165 of them were clear renal cell carcinoma. Median age was 70.41 years, and the Female/Male rate was 28% and 72%, respectively. 4% women and 30% men smoked ≥20 cigarettes/day, more frequently during the period 1999-2001. 52% women and 30% men had hypertension. Hematuria was the most frequent symptom (23%), more frequent in the period 2007-2010, followed by abdominal pain (16%) and renal colic(13%). Weight loss (12%) was more frequent between 1999-2000. Asthenia appeared as the first symptom in 8% of cases. The tumor was incidentally diagnosed in 20% of cases, more frequently in the period between 2007-2010. Diagnosis was established in the Urology Department in 36% of the cases. Stages T1-2 N0 were more frequent between 2007-2010, and M1 between 1999-2000. G3 was more frequent in the entire series. The relative cancer specific mortality of patients who were surgically treated was less in the last 2 years of the period. CONCLUSIONS Clear renal cell carcinoma is the most frequent renal cancer and its incidence is increasing in our environment. It affects more frequently males than females, and at an earlier age. The last few years are showing a decrease in the habitual smoker males and an increase in HTN in females. A tendency has been detected to the early stage clinical diagnosis but with a higher histopathological grade. It is most frequent diagnosed by a non-Urology speciality.
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Affiliation(s)
- M F Lorenzo-Gómez
- Urology Department, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Spain.
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Lorenzo-Gómez MF, Padilla-Fernández B, García-Criado FJ, Mirón-Canelo JA, Gil-Vicente A, Nieto-Huertos A, Silva-Abuin JM. Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics. Int Urogynecol J 2012; 24:127-34. [PMID: 22806485 PMCID: PMC3536982 DOI: 10.1007/s00192-012-1853-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/03/2012] [Indexed: 08/30/2023]
Abstract
Introduction and hypothesis Urinary tract infections (UTIs) are considered the most common bacterial infections, especially in women. The objective of this study was to evaluate the use of the sublingual bacterial vaccine Uromune® in order to prevent recurrent UTIs (RUTIs). Methods This study was conceived as a multicenter observational study. The clinical history of 319 women who presented at least 2 episodes of UTI in the last 6 months or 3 in 12 months was reviewed. Data related to treatment and clinical evolution were recorded and analyzed. A total of 159 patients received prophylactic treatment with Uromune® for a period of 3 months (group A) and 160 with sulfamethoxazole/trimethoprim 200/40 mg/day for a period of 6 months (group B). Uromune® contained an inactivated bacterial cell suspension of selected strains of Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. Results Patients in group A experienced a highly significant reduction in the number of infections compared to patients in group B. In the first 3 months, the mean number of infections was 0.36 versus 1.60 (P < 0.0001), respectively. A significant reduction was also observed after 9 and 15 months (P < 0.0001). The numbers of patients who did not have any UTI at 3, 9, and 15 months were 101, 90, and 55 in group A versus 9, 4, and 0 in group B (P < 0.0001). Conclusions The results obtained in this study favor the use of this bacterial-based therapeutic vaccine as an effective strategy to reduce frequency, duration, severity, and costs of RUTIs.
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Affiliation(s)
- M F Lorenzo-Gómez
- Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, Instituto de Investigación Biomédica de Salamanca, 37007, Salamanca, Spain.
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Padilla-Fernández B, Antúnez-Plaza P, Lorenzo-Gómez MF, Rodríguez-González M, Martín-Rodríguez A, Silva-Abuín JM. Paraganglioma of prostatic origin. Clin Med Insights Case Rep 2012; 5:69-75. [PMID: 22661903 PMCID: PMC3364107 DOI: 10.4137/ccrep.s9742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Paragangliomas are usually benign tumors arising from chromaffin cells located outside the adrenal gland. Prostatic paraganglioma is an unusual entity in adult patients, with only 10 cases reported in the medical literature. CASE REPORT A 34-year-old male with a history of chronic prostatitis consulted for perineal pain. On digital rectal examination the prostate was enlarged and firm, without nodules. The PSA level was 0.8 ng/mL and the catecholamines in the urine were elevated. On ultrasound a retrovesical 9 cm mass of undetermined origin measuring was present. A PET-CT scan showed a pelvic lesion measuring 9 cm with moderate increase in glucidic metabolism localized in the area of the prostate. A biopsy of the prostate revealed a neuroendocrine tumor, possibly a prostatic paraganglioma. A body scintigraphy with MIBG I-123 ruled out the presence of metastases or multifocal tumor. A radical prostatectomy with excision of the pelvic mass was performed under adrenergic blockade. One year after surgery the patient is asymptomatic and disease free. DISCUSSION/CONCLUSIONS Prostatic paraganglioma is a rare, usually benign tumor, which should be considered in the differential diagnosis of prostate tumors in young males. Its diagnosis is based on the determination of catecholamine in blood and 24-hour urine and in imaging studies principally scintigraphy with MIBG I-123. Diagnostic confirmation is by histopathological study. The treatment consists of radical resection under adrenergic blockade and volume expansion. Given the limited number of cases reported, it is difficult to establish prognostic factors. Malignancy is defined by clinical criteria, and requires life long follow-up.
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Lorenzo-Gómez MF, Gómez-García A, Padilla-Fernández B, García-Criado FJ, Silva-Abuín JM, Mirón-Canelo JA, Urrutia-Avisrror M. [Risk factors for failure after transobturator vaginal tape for urinary incontinence]. Actas Urol Esp 2011; 35:454-8. [PMID: 21550142 DOI: 10.1016/j.acuro.2011.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/13/2011] [Accepted: 03/14/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify risk factors leading to treatment failure in a sample of 302 women with stress urinary incontinence (SUI) treated by transobturator vaginal tape (TOT) with a medium follow-up of 4 years (range 1-6). MATERIAL AND METHODS A population based cohort study with prospectively data from 302 women, aged 41-81 years underwent TOT between April 2003-November 2010. Data were collected by validated questionnaire on urinary incontinence, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), and clinical data-records. Continence was achieved in 262 (Group A) and 40 continued with incontinence (Group B). We investigated the relationship between age, SUI evolution time, type and number of childbirths (eutocic, dystocic, nulliparous, multiparous status) and medical and/or surgical backgrounds. The ICIQ-SF questionnaire was used to describe whether the surgery outcomes were successful or not. RESULTS Group A were younger (p=0.0001), had less SUI evolution time (p=0.017); more eutocic childbirths (p=0.000018). Group B had more dystocic childbirth (p=0.022), previous tension free vaginal tape (TVT) or TOT (p=0.03.), antidepressant-anxiolytic drugs (p=0.003), antihypertensive drugs (p=0.0005), type 1 diabetes (p=0.02), arterial hypertension (p=0.0007), respiratory diseases (p=0.025). Differences were not found with regard to nulliparous (p=0.701), multiparous status (p=0.42), obesity (p=0.18), intestinal disorders (p=0.59), oophorectomy (p=0.19), caesarean (p=0.17), prolapse surgery (p=0.29), hysterectomy (p=0.57), allergies (p=0.48), arthritis (p=0.22), arthrosis (p=0.44), depression (p=0.74), type 2 diabetes (p=0.44), smoking patterns (p=0.28), fibromyalgia (p=0.47). CONCLUSIONS Elderly women, with long evolution SUI, dystocic delivery, previous TVT or TOT appear as independent risk factors associated to TOT failure. These factors may make the indication of another surgical approach recommendable.
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Affiliation(s)
- M F Lorenzo-Gómez
- Servicio y Cátedra de Urología, Hospital Universitario de Salamanca, Universidad de Salamanca, España.
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Abstract
PURPOSE We describe the successful repair of a large and complex urethral diverticulum in a female by transvaginal approach. Epidemiology, diagnostic methods, treatments and complications of female urethral diverticula are reviewed. PATIENTS AND METHODS A 35-year-old woman with a history of postvoid dribbling, dyspareunia and recurrent urinary tract infections for 4 months was referred. Magnetic resonance imaging demonstrated two fluido-filled collections in the pelvis of 3.5 and 1 cm in size respectively which may be a very large and complex diverticulum, however, Bartholin gland cyst could not be rule out. Cystourethroscopy revealed a urethral diverticulum at 10 mm from the bladder neck with two ostia. It was performed transvaginal diverticulectomy and an anterior vaginal wall flap was placed. The published literature on female urethral diverticula was identified using a Pubmed Medline search and analysed. RESULTS Convalescence was unremarkable. Suprapubic cystostomy tube was removed 2 weeks after surgery. The patient regained normal voiding. In the published literature there are no agreement neither in the diagnostic nor in the surgical techniques for female urethral diverticula. CONCLUSIONS Urethral diverticula are diagnosed with increasing frequency. However, this entity continues to be overlooked because the symptoms may mimic other disorders. Cystourethroscopy, retrograde urethrograme using a double balloon catheter and recently magnetic resonance imaging may diagnose this disease. The cure rate of urethral diverticula with appropriate surgical management has a range of 86-100%. Complete excision through the anterior vaginal wall is the most successful treatment modality with minimum postoperative complications.
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Affiliation(s)
- A Gousse
- Departamento de Urología, Universidad de Miami, Miami, Florida, USA
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