Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

The International Prostate Symptom Score (IPSS) assesses lower urinary tract symptoms (LUTS). In our Department, we receive Mayan-speaking patients with low educational levels, which makes it difficult for them to understand the questionnaire. The visual prostate symptom score (VPSS) overcomes these barriers. Objectives: To correlate the VPSS score with the IPSS one, in patients with LUTS who attend the Urology Department of the Hospital Regional de Alta Especialidad, to determine the prevalence of patients requiring assistance in answering both instruments. The correlation between the IPSS and VPSS and the Qmax of these patients will be evaluated. Material and methods: A comparative cross-sectional study was performed in men of 40 years of age or older with LUTS, between January 2019 to January 2020. Uroflowmetry was performed and the VPSS and IPSS were applied to them, identifying those who required help to answer the questions. Pearson or Spearman correlation tests were performed according to the distribution of the data, evaluated using the Kolmogorov-Smirnov test. Categorical variables were compared using X2 or Fischer's test. Results: Eighty-one men with LUTS were included. The mean age was 62.89+9.52. A significant correlation was found between total VPSS and total IPSS (r=0.708, p<0.001). 83.8% (n=67) of patients were able to answer the IPSS, and 98.8% (n=79) were able to answer the VPSS. The percentage of patients who required help to solve the IPSS was 43.5% (n=34) and the VPSS was 25% (n=20). No significant correlations were found between VPSS and Qmax (r=-.123, p=0.277), and IPSS and Qmax (r=-0.085, p=0.456). Conclusions: The VPSS is a useful instrument in the assessment of LUTS, as it correlates with the IPSS. It also overcomes the barriers of language and educational level. However, it overestimates the severity of the symptoms referred by the patient. Then, studies are needed to improve this instrument.

Introduction: Surgery by lumboscopic approach is of choice for some work groups, despite being more arduous and requiring a higher learning curve. Objective: To assess the lumboscopic approach and identify predictive factors of complications and conversion to open surgery. Material and Methods: A transversal, retrospective study of 436 patients that underwent surgery by lumboscopy at the National Center for Minimally Invasive Surgery, 2008-2019. Absolute and relative frequencies; the Chi-Square Test and Student´s t Test and the Multiple Logistics Regression, were utilized, (p≤0.05). Results: Renal atrophy due to benign diseases (49.8%), renoureteral lithiasis (26.6%), surgery of moderate complexity (71.9%) prevailed, such as nephrectomy (50.2%). 16.1% had undergone prior surgery, and 12.4% a urinary derivation. 3% required conversion to open surgery and 18.8% presented complications. Renal staghorn and non-staghorn lithiasis, surgical technique, level of complexity of the surgery, operative time, transoperative bleeding and length of hospital stay were significantly associated (p<0.05) to complications, but after measuring logistics regression, only hospital stay resulted statistically significant (p=0.000). Regarding conversion: gender, past history of prior surgery, operative time and bleeding were significantly associated (p<0.05) in both the univariate and multivariate analysis. Conclusions: Nephrectomy due to benign causes and surgeries of moderate complexity prevailed in this series. The perioperative outcomes were satisfactory and the most frequent complications were postoperative, infectious and of grade II severity. Longer hospital stay was a predictive factor for complications whereas males, past history of prior surgery, longer operative time and bleeding were identified as predictive factors for conversion to open surgery.

Introduction: Anorectal malformations (ARMs) are one of the most frequent congenital malformations in pediatric surgery. Its estimated incidence ranges between 1 in 2000 and 1 in 5000 live newborns approximately. The aim of the work is to present the associated urinary anomalies and functional renal outcomes in patients with worse prognosis anorectal malformations treated in our department Material and methods: A retrospective review of the patients operated at our center with complex anorectal malformations was performed, including urological abnormalities and long-term renal follow-up. Collected data included the type of urinary abnormality, classified as high or low, renal function (glomerular filtration rate and blood creatinine level), the presence of chronic kidney failure (CKD), the need for surgery to correct the urinary abnormality, the need for kidney transplantation and complications and long-term results. Results: A total of 55 patients were included, 32 girls and 23 boys. Mean age at the time of corrective surgery for the anorectal malformation was 9 months (SD 2.18). The mean follow-up of the patients was 13 years (SD 7.01). Sixty-nine per cent of the patients presented some urological anomaly, being more frequent in the cloacal group. Renal structural abnormalities were found in 22 (40%) of 55 patients. They were identified in 11 (47%) cloacal patients, being the most frequent renal dysplasia (n=7; 32%), followed by position abnormalities in 3. Regarding the lower urinary tract anomalies, it was described in 32 (58%) patients. In the cloacal group, the incidence was 65%, being the most frequent vesicoureteral reflux (n = 14, 60%) as well as in the group of patients with a fistula to the prostatic urethra and in the group with exstrophies of the cloaca (n = 3, 42%). Regarding the rest of the lower urinary tract anomalies, the general incidence of anatomic bladder anomalies (bladder diverticulum, patent urachus) was 15%. As a pathology related to the upper urinary tract: primary obstructive megaureter 5%, ureterocele 1% and posterior urethral valves 1%. Conclusions: Patients with complex anorectal malformations have a significant risk for renal impairment. Adequate screening, high level of suspicion, treatment and long term follow up of any associated urinary anomaly in patients with complex anorectal malformations is essential to preserve renal function and prevent CKD. Care by a multidisciplinary team and adequate transition to adulthood is essential to optimize the medical management of patients and long-term outcomes.

  Backround. In 1986, Fowler et al. described a syndrome in which young women suffered of an unexplained urinary retention associated to a weak relaxing external urethral sphinc­ter. Electromyographic studies have shown an abnormal activity of the urethral sphincter in Fowler´s Syndrome women, suggesting that urinary retention is due to an ephaptic transmission of impulses between their muscle fibers. However, this syndrome is yet unknown and underdiagnosed. Objective. To know the micturition characteristics and uroflowmetry of Fowler´s Syndrome patients attended at the Centro de Urología Avanzada CURA at Delicias city, Chihuahua, Mexico, from January 2018 to January 2021. Material and methods. Clinical records were examined from patients who attended the consultation and were diagnosed with the Fowler´s Syndrome. The demographic characteristics, evolution time process, mayor symptoms, residual post-voiding volume, bladder diary and the uroflowmetry using surface EMG, were determined. Results. Ten women were diagnosed with the Fowler´s Syndrome and presented a clinical record of acute urinary retention (AUR). The mean age was 41.4 ±17.51 years old and the mean of the syndrome evolution was 31.2±23.46 mo. The mean urinary frequency was 14.2±4.75 micturitions/24h, the mean of the Qmax was 22.74±11.49 cc/s. the mean voided volume was 198.30±89.54cc and the mean of post void volume was 231.5±86.12 cc. EMG in all patients showed a hypertonic and lack of relaxation pattern. Conclusions. In the clinic, Fowler´s syndrome exhibits chronic urinary retention with repetitive urinary infections without intravesical obstruction. Its diagnosis is possible through non-invasive urodynamic procedures such as uroflowmetry accompanied urethral surface EMG and post void volume assessment.

Abstract Although men are four times more frequently diagnosed than women with urothelial bladder cancer, clinical outcomes greatly differ between both genders, as women present a higher lethality rate, as well as a greater loss of life expectancy. At diagnosis, women present more advanced clinical stages, situation which has led to many efforts to elucidate the social determinants of health and the biological factors implied. Women face different challenges associated with a delay in both, diagnosis and treatment, a more limited access to systemic treatment, and lower response rates associated with immunotherapy. Women are underrepresented in the main chemotherapy, immunotherapy, and other systemic treatment trials, as they comprise only 15 to 25% of the overall population, limiting the possibility of drawing any definitive conclusions. Furthermore, through gene expression analysis, women have been linked to a more aggressive biological subtype of bladder cancer (basal), a higher rate of FGFR 1-4 mutated tumors, lower rate of NECTIN-4 expression, and a higher prevalence of germline mutations. Despite the worse prognosis, sex-based recommendations have not been developed. Cancer care teams must not hinder access to treatment options based on sex and should strive for an equitable cancer care.

  Objective: To demonstrate the changes in the urodynamic parameters of patients with posterior sacral neuromodulation and compare these changes to their pre-implantation parameters. Design: Observational, retrospective, comparative study of related variables. Urodynamic studies were performed on neurological patients who were candidates for posterior sacral neuromodulation (n=9). The candidates for a definitive neuromodulator underwent comparative statistical analysis using student´s t test for related samples. We evaluated on pressure-flow study: maximum flow, Pdet max, effectiveness of voiding, and compliance. Results: Statistically significant results were found in the urodynamic measurements at peak flow (Qmax p<0.002) and in changes in detrusor pressures (p<0.001), there were no statistically significant differences found in voiding effectiveness (p=0.02).  Limitations of the study-implication: A larger number of patients are needed to compare our results to international reports, and to adjust the time of implantation after neurological lesions, since our sample was very heterogeneous. Originality: There are no reports of sacral neuromodulation in Mexican patients exclusively with neurological disorders as described in other populations; this sample is being described as the largest population of neuromodulator carriers with neurourological diseases in Mexico. Conclusions: In spite of not finding differences in the effectiveness of voiding in our sample, this difference is of great clinical importance since it means a decrease in or suspension of clean intermittent catheterization, which is probably also reflected in the changes of the detrusor pressures that are within the limits and has benefits for the patient as protection of the upper urinary tract and a decrease of expenses.

Urinary incontinence post-radical prostatectomy is a common complication that might negatively impact patients’ quality of life. Treatments include medical and surgical options, being the insertion of an artificial urethral sphincter (AUS) the gold standard. The aim of this narrative review is to evaluate the outcomes of artificial urinary sphincter implantation for urinary incontinence developed post-radical prostatectomy with and without radiation, in terms of urinary continence and complications. The MEDLINE and Scopus search returned 477 articles. A total of eleven articles were included for qualitative analysis. A total of 707 men that met the inclusion criteria were included. The 22.6% of the men (160 patients) received pelvic external beam radiotherapy prior to the implantation of the artificial urinary sphincter. The overall continence success rate was defined by the use of pads. Some authors reported a success rate of 0 pads per day (PPD) or ≤ 1 PPD in the last follow-up. The complications included urethral atrophy, mechanical failure, revision and/or removal of the device, infection and erosion. Further prospective studies should be done to clarify continence concepts after the placement of an AUS and long-term complications.

Objective: To evaluate the incidence, possible risk factors and management of rectal injury during radical prostatectomy. Design, methodology or approach: Rectal injury is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited as most studies are based on relatively small series. A total of 147 laparoscopic radical prostatectomies were retrospectively reviewed from January 2017 to April 2021. Four patients with rectal injury were found during the procedure. Results: Of the total number of patients with rectal injury during the procedure, there was extraprostatic extension in the pre-surgery MRI in 50% of the patients. None had a history of previous RT. Primary closure was performed using two layers of suture in all cases. In one case (25%) an intraoperative colostomy was performed. One of the four patients (25%) developed a rectal fistula with secondary peritonitis for which he had to undergo another operation. The time on absolute diet varied from 0 days to 2 days and the time of antibiotic therapy differed in all patients. Discussion: Rectal injury occurs in 0.1-1.8% of patients undergoing radical prostatectomy and significantly increases the morbidity of the procedure. Most rectal injuries occur during plane dissection maneuvers between the seminal vesicles, prostate, and rectum. To detect it, it is recommended to perform a digital rectal examination and insufflate air through the rectum intraoperatively. The risk factors for its appearance are previous RT, an advanced tumor and a low experience of the surgeon in the procedure. The interposition of tissue in rectal defects continues to generate controversy. Despite primary closure, there is a risk of rectal fistula, especially in cases of defects larger than 2 cm, previous RT, or tumor infiltration of the rectum. Conclusions: Rectal injury is a rare but serious complication that can complicate the postoperative period of radical prostatectomy.

  The main indications for urinary tract drainage are pyonephrosis, preservation of renal function in case of distal obstruction and urine diversion in cases of distal urinary fistula or leak. These urinary tract drains include nephrostomies, placement of a nephroureteral catheter or a double-J stent. In this article we review urinary drainage and the selection of the best device according to the type of solution that is intended to be given to a certain clinical setting.

Immune surveillance is one of the most important hallmarks of cancer. In the last decade many advancements in cancer treatment have been developed, much of them are related to the use of the immune system. Renal Cell Carcinoma is the most frequent type of kidney cancer followed by urothelial carcinoma. For years, treatment of Renal Cell Carcinoma has been conflictive as these tumors do not respond well to chemotherapy and have shown to be susceptible to immunotherapies as interferon and interleukin 2. The discovery of the immune checkpoints and their possible roles in cancer treatment led to the synthesis of novel drugs that can target and inhibit the interaction of certain molecules that are important for immunologic homeostasis. In this concise review, we summarize the evidence related with immune checkpoint inhibition for the treatment of renal cell carcinoma, especially for metastatic renal cell carcinoma.