Vitor Cavadas

Prostate Cancer Prevention Trial and European Randomized Study of Screening for Prostate Cancer Risk Calculators: A Performance Comparison in a Contemporary Screened Cohort

BACKGROUND Several models can predict the risk of prostate cancer (PCa) on biopsy. OBJECTIVE To evaluate the performance of the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators in detecting PCa in a contemporary screened cohort. DESIGN, SETTING, AND PARTICIPANTS We analyzed prebiopsy characteristics of 525 consecutive screened patients submitted to biopsy, as required by the risk calculators, in one European center between 2006 and 2007. MEASUREMENTS Comparisons were done using tests of accuracy (area under the receiver operating characteristic curve [AUC-ROC]), calibration plots, and decision curve analysis. Biopsy predictors were identified by univariate and multivariate logistic regression. RESULTS AND LIMITATIONS PCa was detected in 35.2% of the subjects. Among predictors included in the calculators, the logarithmic transformations of prostate volume and prostate-specific antigen (PSA), digital rectal examination, previous biopsy status, and age were significantly associated with PCa; transrectal ultrasound abnormalities and family history were not. AUC-ROC for the ERSPC calculator was significantly higher than the PCPT calculator and PSA alone (80.1%, 74.4%, and 64.3%, respectively). Calibration plots showed better performance for the ERSPC calculator; nevertheless, ERSPC may underestimate risk, while PCPT tends to overestimate predictions. Decision curve analysis displayed higher net benefit for the ERSPC calculator; 9% and 23% unnecessary biopsies can be avoided if a threshold probability of 20% and 30%, respectively, is adopted. In contrast, the PCPT model displayed very limited benefit. Our findings apply to a screened European cohort submitted to extended biopsy schemes; consequently, caution should be exerted when considering different populations. CONCLUSIONS The ERSPC risk calculator, by incorporating several risks factors, can aid in the estimation of individual PCa risk and in the decision to perform biopsy. The ERSPC calculator outperformed the PCPT model, which is of very limited value, in a contemporary cohort of screened patients.

The quality of reporting of randomized controlled trials in pelvic organ prolapse

Introduction and hypothesisRandomized controlled trials (RCTs) must comply with the strict rules of design and conduct and their reporting should reflect it. Our aim was to evaluate how the quality of RCT reporting in pelvic organ prolapse (POP) has evolved.MethodsRCTs in POP published between 1997 and 2010 were retrieved through a PubMed search. The quality of reporting was assessed by applying the 2010 revised Consolidated Standards of Reporting Trials (CONSORT) statement. Appropriate statistical analysis was performed.ResultsForty-one RCTs were identified for review. The implementation of randomization, recruitment, blinding, outcomes with effect size and precision, trial registration, and full protocol availability were reported in less than half of the trials. Comparing two periods (1997–2006 and 2007–2010), there was no improvement in the quality of reporting for any of the CONSORT criteria.ConclusionsRCTs in POP are scarce. The quality of reporting is suboptimal in many aspects and has not improved in recent years.

Female Sexual Function and Depression After Kidney Transplantation: Comparison Between Deceased- and Living-Donor Recipients

Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression Inventory-II (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearmans rho = -0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, living-donor transplantation exerted a positive effect on womens sexual function.

Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis.

Studers neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studers orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.

Endoscopic removal of an intravesical calcified sling using pneumatic lithotripsy and cystoscopic resection.

The transobturator tape procedure is a minimally invasive treatment for stress urinary incontinence. The widespread use of these slings has led to an increase in the number of rare complications, such as bladder erosion. Although in the last few years several minimally invasive techniques have been described, surgical management of such complications remains an open issue. We report a case of a bladder stone formed on a transobturator sling after unrecognized bladder perforation. Using pneumatic lithotripsy, the calculus was fragmented and the intravesical portion of the tape was successfully excised and removed by transurethral resection and endoscopic scissors. This minimally invasive transurethral technique is challenging but can be a safe and successful way to deal with such rare complications.

MP77-13 A PROSPECTIVE EVALUATION ON THE EFFECT OF INTER-OBSERVER VARIABILITY OF DRE ON THE PERFORMANCE OF THE DRE BASED ROTTERDAM PROSTATE CANCER RISK CALCULATOR

were graded from 0-10 (0: no pain/willing to return for repeat procedure; 10: excruciating pain/not willing to return for repeat procedure). Procedures were performed by a single urologist with a 1% Lidocaine periprostatic nerve block. Pain scores between groups were compared via Mann-Whitney U test. RESULTS: A total of 94 patients were included, with 50 FusionBx+TRUSBx and 44 TRUSBx. For each group, median age was 66.5 (range 47-84) and 68 years (range 44-86), and median number of cores was 14 (range 12-22) and 12 (range 6-14), respectively. Prostate biopsy pain questionnaire scores did not differ significantly for any of the questions (Figure 1). Patients in both groups had mild discomfort overall with the procedure (3 out of 10), the probe insertion (2 out of 10) and the biopsy portion of the exam (3 out of 10). If medically necessary, both groups were very willing to come back for the same procedure again (1 out of 10). CONCLUSIONS: Patients reported no difference in pain or discomfort with added FusionBx relative to TRUSBx alone. Both procedures were mildly painful with patients very willing to return for repeat biopsy if necessary. Patients tolerate the addition of FusionBx to TRUSBx alone. Patients0 pain experience or discomfort does not seem to hinder whether FusionBx of the prostate should be performed, or not.

Prospective evaluation on the effect of interobserver variability of digital rectal examination on the performance of the Rotterdam Prostate Cancer Risk Calculator

To assess the level of agreement between digital rectal examination findings of two urologists and its effect on risk prediction using the digital rectal examination‐based Rotterdam Prostate Cancer Risk Calculator.

Micronefrolitotomia Percutânea: Descrição de uma Variante da Técnica Original

The micropercutaneous nephrolithotomy (microperc) is the ultimate technological advance in the treatment of urolithiasis. We describe a variation of the original technique and it´s additional advantages to this surgical approach. A woman of 67 years old with a body mass index of 28.6 kg/ m2 with a stone of 25 x 20 mm in the left renal pelvis was positioned in Valdivia - Galdakao decubitus. After retrograde pielography, it was placed a ureteral access sheath 11/13 F to the level of the ureteropelvic junction. The puncture of the kidney was performed under fluoroscopic guidance. The stone was disintegrated with holmium laser. At the end of the procedure it was performed a flexible nephroscopy to comprove the stone free status.

What about vaginal extraction of the kidney? results of an online survey

ABSTRACT Purpose We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. Results Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). Conclusions Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.