Although the artificial urinary sphincter (AUS) remains the gold standard for treating men with moderate to severe stress urinary incontinence (SUI), management of urethral cuff erosion is a feared complication that is often debated. Though contemporary descriptions of cuff erosion management report a role for urethroplasty at the setting of device removal, most of these series are limited by single-institutional designs with small cohorts and short-term follow-up. Here we describe the natural history and clinical course of men who have undergone AUS cuff explantation for erosion in a large, international cohort that could provide valuable insights into future management. To describe the natural clinical history of patients who have undergone initial artificial urinary sphincter explantation for urethral cuff erosion. A multi-institutional, retrospective review of patients from Jan 1997 to Jul 2017 was conducted and all patients that experienced at least one AUS cuff erosion were identified. Patient demographics, medical comorbidities, device characteristics, and surgical outcomes were assessed with particular attention to index AUS cuff explantation and subsequent AUS procedures. Statistical significance was defined by a p-value <0.05.

Objective: To assess the effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in patients with prostate cancer (PCa) after 6 months of treatment with luteinizing hormone-releasing hormone (LHRH) analogues. Material and methods: Prospective, observational, multicentre, open-label study of patients diagnosed with nonmetastatic or asymptomatic metastatic PCa scheduled to receive LHRH analogues for >= 6 months. We assessed four CP domains at baseline and after 6 months of ADT: 1) Working memory: Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Subtest (WAIS ill-Digit); 2) Visual memory: ad hoc visual memory test; 3) Visuospatial ability: Judgement of Line Orientation (JLO) and Mental Rotation of Three-Dimensional Objects (3D-Rotation); and 4) Nonverbal analytical reasoning: WAIS III Matrix Reasoning Test (WAIS III-MRT). Changes outside the baseline 95% confidence intervals were considered significant. Results: A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test and 63 patients (20.4%) experienced significant changes in >= 1 test. Of these, most presented a change in only one test, distributed evenly between improvements (58 patients; 18.8%) and worsening (56 patients; 18.2%). For individual tests, most patients (87.8% to 91.8%) had no change from baseline; however, the significant changes (improvement vs. deterioration, respectively) were as follows: WAIS III-Digit (6.3% vs. 5.9%); visual memory (5.3% vs. 5.7%); JLO (5.3% vs. 4.5%); 3D-Rotation (4.1%vs. 4.1%); and WAIS III-MRT (4.8% vs. 5.8%). Conclusions: CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration. (C) 2017 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

ObjetivoComparar diferentes opciones de tratamiento conservador del tumor vesical no músculo-invasivo (TVNMI) T1 de grado alto. El bacilo de Calmette-Guérin (BCG) es el tratamiento intravesical preferido para los tumores T1 de grado alto; sin embargo, algunos expertos aún cuestionan la necesidad de la BCG de mantenimiento.Materiales y métodosSe analizaron retrospectivamente los datos de 1.039 pacientes con TVNMI T1G3 primario y recurrente. Todos los pacientes fueron tratados mediante una resección transuretral del tumor vesical (RTUTV) completa, con músculo en la muestra y múltiples biopsias de la vejiga. Los pacientes fueron tratados con solo una RTUTV inicial (n=108), re-RTUTV (n=153), inducción con 27mg de BCG (cepa Connaught) (n=87), inducción con 81mg de BCG (n=489) o inducción con 81mg de BCG+mantenimiento (n=202). El tiempo hasta la primera recidiva, progresión (a T2 o mayor, o a enfermedad metastásica) y mortalidad específica de la enfermedad se evaluaron mediante la función de supervivencia de Kaplan-Meier y se compararon utilizando la prueba de logaritmo del rango (log-rank) y el modelo multivariado de regresión de Cox de riesgos proporcionales.ResultadosEl seguimiento medio fue de 62±39 meses. El riesgo de recurrencia fue significativamente menor en los pacientes tratados con terapia de mantenimiento con 81mg de BCG que en los otros grupos de tratamiento (p<0,001). El riesgo de progresión del tumor también fue significativamente más bajo en los pacientes tratados con mantenimiento con BCG que en los pacientes tratados solo con una RTUTV, re-RTUTV y con terapia de inducción con 27mg de BCG (p=0,0003). La mortalidad específica de la enfermedad fue significativamente más baja con el mantenimiento con BCG (9,4%) que con solo una RTUTV (27,8%; p=0,003).ConclusionesEn el caso del TVNMI T1G3, la dosis completa de BCG con mantenimiento va asociada a mejores resultados de recurrencia que otras modalidades de tratamiento conservador. Los resultados de progresión y de supervivencia específica de la enfermedad también fueron mejores con la BCG de inducción, con o sin mantenimiento.

Objective: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guerin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG.Material and methods: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n = 108), re-TURBT (n = 153), induction with 27 mg of BCG (Connaught strain) (n = 87), induction with 81 mg of BCG (n = 489) or induction with 81 mg of BCG + maintenance (n = 202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks.Results: The mean follow-up was 62 +/- 39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81 mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27 mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003).Conclusions: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Achilles tendinopathy is an overuse syndrome, common among runners, with sometimes considerable negative impact on their performance, overall health, and well-being. Our report shows that local injection of an aqueous solution of the diethylammonium salt of dobesilate, an inhibitor of fibroblast growth factor with significant anti-angiogenic and anti-inflammatory effects, is effective in reducing vascular density and pain in insertional Achilles tendinopathy.

We have evaluated the effects of intravitreal dobesilate, a synthetic fibroblast growth factor inhibitor, in patients with dry age-related macular degeneration, an inflammatory-related retinal disease without available treatment up to date. 36 eyes from 36 patients with dry age-related macular degeneration were treated with a single intravitreal dobesilate injection. The end points were the improvement from baseline visual acuity and normalization of retinal histology at one month. Intravitreal dobesilate injection resulted in a significant improvement in functional and anatomical outcomes at one month after injection. Our results suggest that intravitreal dobesilate may increase the chance of visual acuity gain in dry age-related macular degeneration, even in cases with initial low vision. This study supports the findings of previously published case reports, regarding the short-term improvement in visual acuity by intravitreal dobesilate injection in different degenerative retinal diseases.

Wet age-related macular degeneration is associated with chronic ischemia and inflammation that upregulate several inflammatory cytokines and growth factors, particularly vascular endothelial growth factor and fibroblast growth factor which promote the growth of choroidal neovascularization. Only with the introduction of drugs that directly inhibit the actions of vascular endothelial growth factor have ophthalmologists been able to offer patients with wet age-related macular degeneration reasonable hope for improvement of vision. However, intravitreal administration of anti-vascular endothelial growth factor drugs could be associated with unexpected ocular and systemic side effects. We present consecutive case series of 64 eyes of 64 patients with wet age-related macular degeneration treated with a single intravitreal injection of Dobesilate, a synthetic fibroblast growth factor inhibitor. The end points were the improvement from baseline visual acuity and normalization of retinal histology at 1 month. Intravitreal Dobesilate injection results in a significant improvement in functional and anatomic outcomes from the first month after injection. There were no cases of treatment-associated complications.

ObjetivosExplorar la opinión de los urólogos españoles respecto a los principales puntos en el diagnóstico, prevención, calidad de vida y tratamiento del cáncer de próstata.Material y métodosSe administró un cuestionario anónimo a 290 especialistas que representan el colectivo profesional urológico involucrado en el manejo del cáncer de próstata en España. En su definición se tuvo en cuenta el grado de experiencia profesional, el ámbito de trabajo, la relación contractual con el paciente y el carácter académico del centro. El análisis estadístico se basó en el estudio de frecuencias relativas para variables cualitativas. La interpretación de resultados se llevó a cabo en 2009-2010 y el informe de emisión final de los mismos en 2011.ResultadosLa tasa de respuesta recogida y correctamente transcrita de los formularios fue del 96,9% (n=281), lo que supone un 10-15% del colectivo nacional. La mediana de edad fue 47,7 (29-69) años y el 92% fueron hombres. La mediana de experiencia profesional fue 19,1 (1-43) años. Se analizan las respuestas recogidas relativas a 153 cuestiones que tratan: a) cómo se lleva a cabo el diagnóstico de la enfermedad en el entorno de los encuestados; b) las opiniones vertidas acerca de la prevención de la enfermedad; c) el tratamiento de la enfermedad localizada; d) el tratamiento de la enfermedad avanzada; y e) la definición de campos de interés para el profesional.ConclusiónEsta encuesta demuestra una importante variabilidad en algunos puntos de la práctica clínica con respecto a las recomendaciones de expertos. Pone también en evidencia las principales preocupaciones del profesional, define oportunidades de mejora formativa y detecta necesidades en el colectivo urológico nacional.

Objectives: Study the opinion of the Spanish urologists regarding the main points in the diagnosis, prevention, quality of life and treatment of prostate cancer.Material and methods: An anonymous questionnaire was administered to 290 specialists who represented the urological professional group involved in the management of prostate cancer in Spain. The following were considered in their definition: grade of professional experience, work setting, contractual relation with patient and academic character of the center. The statistical analysis was based on the study of relative frequencies for qualitative variables. The results were interpreted in 2009-10 and the final report of them was done in 2011.Results: Response rate collected and correctly transcribed from the forms was 96.9% (n = 281). This accounts for 10-15% of the national group. Median age was 47.7 (29-69) years and 92% were men. Mean years of professional experience were 19.1 (1-43). Responses collected regarding 153 questions were analyzed. These dealt with: a) How the diagnosis of the disease was carried out in the setting of the surveyed; b) The opinions given on the disease prevention; c) Treatment of the localized treatment; d) Treatment of the advanced disease; and e) The definition of the fields of interest for the professional.Conclusion: This survey showed important variability in some points of clinical practice in regards to the recommendations of the experts. It also shows the principal concerns of the professional, defines opportunities for training improvements and detects needs in the national urological group. (C) 2012 AEU. Published by Elsevier Espana, S.L. All rights reserved.