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) v...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.
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 t...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.
INTRODUCTION: Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review is c...INTRODUCTION: Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review is conducted in accordance with the PRISMA guidelines. MATERIAL AND METHOD: A systematic review was conducted, and 13 clinical trials were included after applying the pre-specified inclusion criteria. The risk of bias and the level of evidence were assessed. Subsequently, the requisite data were extracted in order to present the findings of the studies. RESULTS AND DISCUSSION: The present systematic review establishes that pembrolizumab can be used as adjuvant therapy in patients with advanced renal cancer at high risk after nephrectomy. This is supported by the KEYNOTE-564 study, which concluded that it increased disease-free survival (DFS) and overall survival (OS). The use of sunitinib is discussed, since the study published in NEJM shows a modest benefit in terms of DFS, but only in an independent and blinded central review. According to the PROTECT study, pazopanib has no overall benefit. The EVEREST study showed no significant benefit over everolimus. Further studies are needed to confirm the use of axitinib, as the ATLAS trial showed statistically significant results in DFS in higher-risk population based on investigator assessment, but not based on independent central review. Therapy with 5-FU, α-IFN and IL-2, atezolizumab, sorafenib, thalidomide, nivolumab + ipilimumab should not be used in the adjuvant setting.
Ljubetic BM, Thorogood SL, Becher EF
… +13 more, Alvarez de Toledo I, Carrion R, Carvajal A, Fernández-Pascual E, Martinez-Salamanca JI, Nelson C, Quesada J, Salter CA, Torremade J, D'Anna M, Valenzuela R, Mulhall JP, Flores JM
Actas Urol Esp (Engl Ed)
· 2025 Mar · PMID 39938637
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INTRODUCTION: The Satisfaction Survey for Inflatable Penile Implant (SSIPI) is useful tool to assess patient outcomes after inflatable penile prosthesis (IPP) surgery. However, this survey is not validated in Spanish. Th...INTRODUCTION: The Satisfaction Survey for Inflatable Penile Implant (SSIPI) is useful tool to assess patient outcomes after inflatable penile prosthesis (IPP) surgery. However, this survey is not validated in Spanish. This work aims to report the initial steps carried out for the linguistic validation of the SSIPI translation into Spanish. METHOD: The linguistic validation process had the following steps: (i) SSIPI forward translation, (ii) reconciliation, (iii) back translation, (iv) harmonization, review, and correction of the translation, and (v) cognitive interviewing and testing the new translated version. Urologists from Spain, South America, and the United States participated in these steps. The last step was performed in 3 centers: (i) Medellín, Colombia; (ii) Florida, United States; and (iii) Madrid, Spain. RESULTS: 19 Spanish-speaking patients tested the initial translated version of SSIPI. Most patients found the translated SSIPI questionnaire easy to understand; however, of the 16 questions, patients most frequently commented that questions 3, 5, and 7 should be modified. The median number of observations or comments per question was 1 (1, 3). Based on these suggestions, the research group adapted the questionnaire to obtain the final version in Spanish. CONCLUSION: This study evaluates the initial steps for the translation and linguistic validation of the SSIPI questionnaire into Spanish. The results indicate a remarkable level of readability and comprehension, while some challenges were observed in certain questions. This work demonstrates that a standardized and protocolized process is needed to translate and validate surveys into Spanish.
Madec FX, Neuville P, Chierigo F
… +14 more, Adamowicz J, Białek Ł, Cocci A, Frankiewicz M, Mantica G, Oszczudłowski M, Redmond EJ, Rosenbaum CM, Verla W, Waterloos M, Campos-Juanatey F, Klemm J, Vetterlein M, Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
INTRODUCTION: Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction. M...INTRODUCTION: Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction. METHODS: A comprehensive literature review was conducted using PubMed, focusing on the history of the urethral stricture and current trends based on national and international guidelines for urethral stricture management. RESULTS: Urethral strictures are among the oldest known urological conditions, with initial treatments centred around dilatation. These palliative measures proved disappointing. The advent of reconstructive urology has transformed this pathology into a treatable condition, notably through Excision and Primary Anastomosis (EPA) and one-stage augmentation urethroplasty using buccal grafts. CONCLUSION: Urethroplasty is the gold standard treatment for urethral strictures, and ongoing refinements aim to further reduce morbidity.
Chierigo F, Mantica G, Drocchi G
… +15 more, Madec FX, Verla W, Białek Ł, Adamowicz J, Cocci A, Frankiewicz M, Klemm J, Neuville P, Oszczudłowski M, Redmond EJ, Rosenbaum CM, Waterloos M, Vetterlein MW, Campos-Juanatey F, Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU)
INTRODUCTION: Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring...INTRODUCTION: Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring, and meatal deformities, can impact patient satisfaction, self-image, and quality of life. Despite their significance, cosmetic outcomes are underreported in the literature, affecting patient counseling and surgical planning. OBJECTIVE: This scoping review aims to assess the prevalence, types, and contributing factors of cosmetic complications after anterior urethroplasty. A photographic collection of these complications is also presented to aid in clinical education. MATERIALS AND METHODS: A systematic search of PubMed, Scopus, and Web of Science databases was performed, including studies from 2000 onward that report cosmetic outcomes in male adult patients post-urethroplasty. Following PRISMA guidelines, studies focusing on pediatric cases, case reports with fewer than 10 patients, and those lacking specific cosmetic data were excluded. RESULTS: Of the 493 studies screened, 97 met the inclusion criteria, with only a minority (8 studies) explicitly discussing cosmetic complications. Reported issues varied widely, including penile curvature, skin tethering, hypertrophic scarring, meatal deformities, and penile shortening, underscoring the diversity of aesthetic challenges in urethral reconstruction. CONCLUSION: This review highlights the need for incorporating aesthetic considerations into surgical planning and patient counseling for anterior urethroplasty. Standardized metrics for evaluating cosmetic outcomes could improve patient satisfaction and the quality of care in urethral reconstruction.
Mantica G, Chierigo F, Białek Ł
… +12 more, Madec FX, Frankiewicz M, Verla W, Redmond EJ, Rosenbaum CM, Cocci A, Campos-Juanatey F, Oszczudłowski M, Adamowicz J, Terrone C, Vetterlein MW, en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
OBJECTIVE: The aim of this systematic review is to offer a comprehensive view of the current use of robotic surgery for the treatment of urethral strictures and bladder neck contractures. METHODS: A systematic review of...OBJECTIVE: The aim of this systematic review is to offer a comprehensive view of the current use of robotic surgery for the treatment of urethral strictures and bladder neck contractures. METHODS: A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Embase databases in December 2023. Keywords used were "robotic" and "robotic-assisted" combined with "urethroplasty", "urethral stricture", and "bladder neck contracture". All papers published after 2000, concerning studies conducted on humans for urethral strictures and bladder neck contractures managed with robotic surgery were considered for the review. Only procedures involving a direct approach to urethra/bladder neck and/or graft harvesting for urethroplasty have been included. RESULTS: A total of 275 articles were evaluated after the strategy search and only 11 articles were considered eligible for the final analysis. The studies included a series of between a minimum of 1 and a maximum of 104 patients, for a total of 203 patients. The robotic surgery was performed mainly for the treatment of bladder neck contracture and posterior urethra. In some reports, the robotic system was used for graft harvesting, subsequently used with an open perineal technique. The follow-up presented in the different studies is very heterogeneous. However, most studies have high success rates, with recurrence and redo surgery rates generally below 20%. Likewise, post-procedure incontinence rates are low. CONCLUSIONS: The outcomes presented in the literature, combined with the minimally invasive nature, suggest a possible growing role for robotic surgery in the coming years in the treatment of these diseases.
Frankiewicz M, Adamowicz J, Białek L
… +15 more, Campos-Juanatey F, Chierigo F, Cocci A, Madec FX, Mantica G, Oszczudłowski M, Redmond EJ, Rosenbaum CM, Verla W, Waterloos M, Jobczyk M, Kałużny A, Vetterlein MW, Matuszewski M, Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists
INTRODUCTION: Oral mucosal grafts are essential in reconstructive urology, particularly for urethral and genital defects. Advances in harvesting and implantation techniques have been made, yet perioperative care remains...INTRODUCTION: Oral mucosal grafts are essential in reconstructive urology, particularly for urethral and genital defects. Advances in harvesting and implantation techniques have been made, yet perioperative care remains crucial for optimal outcomes. This systematic review explores postoperative care pathways following oral mucosal graft harvesting to consolidate knowledge, identify best practices, and highlight research gaps. OBJECTIVE: The review aims to identify optimal care pathways, compare different oral care approaches, and address research gaps. METHODS: A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases without time constraints. Key search terms included "oral mucosal graft", "oral care pathways", "OMG post-operative care", "BMG", "LMG", and "OMG graft harvesting". Selection followed PRISMA guidelines. Inclusion criteria focused on studies addressing oral mucosal grafts in reconstructive urology and associated perioperative care, excluding non-English articles, case reports, and editorials. RESULTS: The review underscores the suitability of oral mucosa for grafting due to properties like excellent vascularization and minimal immunogenicity. Comparisons among graft harvesting sites reveal differences in tissue quality, ease of harvest, and donor site morbidity. Non-closure techniques generally result in less postoperative pain and quicker healing, though closure might better control bleeding and infection. Despite common complications such as mild trismus and altered chewing efficiency, patient satisfaction remains high. CONCLUSIONS: Effective management of oral mucosal grafts harvesting emphasizes tailored perioperative care to minimize complications and enhance recovery. Further research should focus on long-term oral morbidity, standardized care protocols, and patient-reported outcomes to improve care pathways and surgical results.
INTRODUCTION: Direct vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing as...INTRODUCTION: Direct vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success. METHODS: We conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success-considered as the avoidance of further interventions for stricture recurrence. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence. RESULTS: Mean stricture length was 1.2 cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU. After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95%IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95%IC 1.6-8), history of previous urethroplasty (OR 2.5, 95%IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95%IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months. CONCLUSIONS: Bulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.
Fes Ascanio E, Ortega Polledo LE, Zegrí de Olivar ME
… +5 more, Muñoz Bastidas CA, Seguí Moya E, Carrión Monsalve DM, Sánchez García M, Campos-Juanatey F
INTRODUCTION AND OBJECTIVE: Assessment of urethral stricture (US) management in a specific group of professionals, Urology Residents, in a specific region (Spain), seems to be important to determine the quality of the ed...INTRODUCTION AND OBJECTIVE: Assessment of urethral stricture (US) management in a specific group of professionals, Urology Residents, in a specific region (Spain), seems to be important to determine the quality of the educational program and design educational interventions to improve it. We aim to investigate diagnosis and therapeutics practices among Urology Residents for the US management. MATERIALS AND METHODS: 20-question on-line survey was conducted among residents and junior consultants registered on the mailing list of residents and young urologists of the Spanish Association of Urology (RAEU) group of the educational period 2018-2023. We evaluated demographic, educational, surgical technics and experience data during the training period. 290 questionnaires were mailed between May-August 2023. Data was collected in a prospective way between May-December 2023. RESULTS: The survey obtained 86 responders, with 29,7% (86/290) response rate. Two first sections were answered by all the responders, however, from the assessment section on, only 57 responders completed the survey, which represents 66,3% of them. CONCLUSIONS: Educational program in Reconstructive Urology among Urology Residents in Spain has an improvement margin. We must dedicate our efforts to standardize the educational process and facilitate access to formation to and increasing area of interest among residents.
OBJECTIVE: To the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al. MATERIAL AND METHODS: Anastomotic reconstruction o...OBJECTIVE: To the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al. MATERIAL AND METHODS: Anastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique. RESULTS: A total of 60 patients were included, with a mean age of 37 years (IQR 22-48). The median time from trauma to urethral reconstruction was 16 weeks, and the mean stenosis length was 2.5 cm (IQR 2-3). The left bulbar artery was preserved in 27 cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14 cases (23%), but only one of them was Clavien ≥ III. With a mean follow-up of 56 months (IQR 12-87), only one patient failed due to stenosis (98% success). CONCLUSION: Preservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.
Verla W, Lumen N, Waterloos M
… +13 more, Adamowicz J, Campos-Juanatey F, Cocci A, Frankiewicz M, Mantica G, Rosenbaum C, Madec FX, Redmond E, Białek Ł, Chierigo F, Oszczudłowski M, Vetterlein M, en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
INTRODUCTION: Neo-urethral stricture formation frequently occurs after phalloplasty and most commonly affects the anastomosis between the fixed and phallic part of the neo-urethra. This narrative review gives an overview...INTRODUCTION: Neo-urethral stricture formation frequently occurs after phalloplasty and most commonly affects the anastomosis between the fixed and phallic part of the neo-urethra. This narrative review gives an overview of the existing literature on how to treat these particular strictures. METHODS: This narrative review is based on a literature search conducted in June 2024. No restrictions in terms of publication date, language or sample size were applied. RESULTS: Treatment options include direct vision internal urethrotomy, anastomotic repair urethroplasty, augmentation urethroplasty with grafts or flaps, multi-stage urethroplasty and urethrostomy. Overall, outcomes of these treatments are worse in transmen than in cismen, mainly due to the specific challenges posed by the neophallus environment. Generally, limited data are available on the treatment options for patients with anastomotic strictures after phalloplasty and, consequently, no clear recommendations can be made. CONCLUSION: This narrative review provides a comprehensive and up-to-date overview of the available literature, which may guide future research and help optimize the outcomes for patients with this complex problem after phalloplasty.
INTRODUCTION: The Optilume® Paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. OBJECTIVE: To descr...INTRODUCTION: The Optilume® Paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. OBJECTIVE: To describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. MATERIALS AND METHODS: Retrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax >10 ml/s. RESULTS: 238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5 cm (0.5-5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5-12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p = 0.126). No significant differences were observed between patients with and without prior urethral manipulation. CONCLUSION: Treatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.
Borque-Fernando A, Pérez-Fentes DA, Rodrigo-Aliaga M
… +6 more, Puente-Vázquez J, Gómez-Iturriaga A, Unda M, Calleja-Hernández MA, Cózar-Olmo JM, Álvarez-Ossorio JL
Triple therapy with docetaxel, androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has demonstrated survival benefits in patients with metastatic hormone-sensitive prostate cancer (mHSPC),...Triple therapy with docetaxel, androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has demonstrated survival benefits in patients with metastatic hormone-sensitive prostate cancer (mHSPC), especially in those with high-risk disease. However, once the use of ADT and docetaxel is established, guidelines do not clearly specify which ARPI is most appropriate. In this work, a literature review to identify phase III clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines on triple therapy in mHSPC was carried out. Evidence and recommendations were qualitatively reviewed to provide guidelines on the most suitable ARPI based on patient risk, disease volume, and nature of metastases (synchronous or metachronous). This review aims to update the previously published consensus on the optimal pharmacological treatment for mHSPC and to expose the opinions of hospital pharmacy, urology and medical and radiation oncology experts.
Bohane E, Murphy M, Chierigo F
… +14 more, Mantica G, Adamowicz J, Campos-Juanatey F, Cocci A, Frankiewicz M, Rosenbaum CM, Verla W, Waterloos M, Białek Ł, Madec FX, Oszczudłowski M, Vetterlein MW, Redmond EJ, Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists
INTRODUCTION: The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regardin...INTRODUCTION: The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias. METHODS: A scoping review of PubMed, EMBASE, and CINAHL + databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review. RESULTS: Men with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias. CONCLUSION: There is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.
Patients with non-muscle-invasive bladder cancer (NMIBC) in the intermediate and high-risk groups must receive adjuvant treatment with intravesical Bacillus Calmette-Guérin (BCG) following transurethral resection (TUR),...Patients with non-muscle-invasive bladder cancer (NMIBC) in the intermediate and high-risk groups must receive adjuvant treatment with intravesical Bacillus Calmette-Guérin (BCG) following transurethral resection (TUR), as it reduces the risk of recurrence and presumably the risk of progression as well. Optimization of BCG efficacy is achieved by administering maintenance therapy. However, since many immunological aspects of the mechanism of action of BCG in the bladder remain unknown, the implementation of the optimal dose, number of instillations, strains and adequate maintenance regimen over the last decades has been heterogeneous. Additionally, this has hindered the interpretation of efficacy in terms of oncologic outcomes. This, together with the shortages of BCG in recent years, have forced scientific societies to adapt their clinical practice guidelines and modify their protocols of adjuvant treatment with BCG. This includes changes to strains, doses, and maintenance during this period of time. This consensus document evaluates the current status of adjuvant BCG treatment and the implications of BCG supply availability in the treatment of patients with NMIBC. It also addresses the implementation of novel therapies that will improve cancer prognosis and the quality of life of patients with NMIBC in the future.
Benign prostatic hyperplasia (BPH) is an increasingly common pathology in the adult male. BPH increases after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® System is an...Benign prostatic hyperplasia (BPH) is an increasingly common pathology in the adult male. BPH increases after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® System is an approved technology designed to treat lower urinary tract symptoms (LUTS) secondary to BPH and is used to perform the prostatic urethral lift (PUL) procedure. Various urology specialists in Spain with experience in PUL have prepared this consensus document. Endorsed by the Spanish Urology Association, its information is based on the most recent findings. The main objective of this document is to disseminate the consensus recommendations among all professionals treating patients with LUTS/BPH. Both primary care physicians and urologists can assess and offer PUL as an effective, minimally invasive treatment.