Browsing by Author "Calvo, Carlos Ignacio"

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    Affirming Long-Term Outcomes After Contemporary Urethroplasty: The Adverse Impact of Increasing Stricture Length, Lichen Sclerosus, Radiation, and Infectious Strictures
    (2024) Calvo, Carlos Ignacio; Fender, Kai; Hoy, Nathan; Rourke, Keith
    Purpose: There is a paucity of reported long-term outcomes after contemporary urethroplasty. Our objective is to determine the long-term success of modern urethroplasty and identify factors associated with stricture recurrence in this context. Materials and Methods: Patients undergoing urethroplasty from July 2003 to May 2013 with at least 100 months of follow-up were identified. Long-term outcomes including stricture recurrence and patient satisfaction were evaluated by review of regional/provincial electronic records and telephone interview. Urethroplasty failure was defined as a recurrent stricture (<16F) confirmed on cystoscopy. Cox regression was used to evaluate variables associated with long-term stricture recurrence. Results: A total of 733 patients were identified with >= 100 months follow-up. Median patient age was 45 years, stricture length was 4.7 cm, and 85.8% failed prior endoscopic treatment. At a median follow-up of 12.3 years, 89 recurrences were observed. Cumulative incidence of stricture recurrence was 6%, 10%, and 12% after 1, 5, and 10 years, respectively. From a patient-reported perspective, 89% of patients reported being satisfied with the outcome of surgery. On multivariable analyses, increasing stricture length (HR 1.1, 95% CI 1.05-1.15; P < .001) and stricture etiology (P < .001), in particular lichen sclerosus (HR 4.46, 95% CI 2.25-9.53), radiation (HR 4.25, 95% CI 1.65-10.9), and infectious strictures (HR 5.27, 95% CI 2.03-13.7), were independently associated with stricture recurrence. Conclusions: This study affirms the widely held belief that modern urethroplasty provides high long-term patency and patient-reported satisfaction. Patients with longer strictures as well as those with lichen sclerosus, radiation, and infectious etiologies have a higher hazard of stricture recurrence in the long term.
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    Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?
    (2023) Arevalo-Vega, Diego; Ponce, Lucas; Valdevenito, Juan Pablo; Gallegos, Hector; Dell'Oro, Arturo; Santis-Moya, Fernanda; Calvo, Carlos Ignacio
    IntroductionBoth detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. MethodsA retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH(2)O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax >= 25 cmH(2)O and Qmax <= 12 mL/s and Solomon-Greenwell female BOO index >= 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. ResultsA total of 195 patients were included. Overall, mean age was 55 +/- 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. ConclusionsPatients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.
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    Laparoendoscopic single-site simultaneous bilateral nephrectomy: first reported case series
    (2021) Musquera, Mireia; Calvo, Carlos Ignacio; Vetorazzo, Jose; Ajami, Tarek; Ribal, Maria Jose; Peri, Lluis; Alcaraz, Antonio
    Bilateral renal tumors in patients on dialysis are usually managed with bilateral nephrectomy. With traditional laparoscopy, this procedure requires the insertion of multiple trocars. Laparoendoscopic single-site surgery (LESS) uses a single umbilical incision to insert multiple instruments and is also employed for extraction of specimens. This technique appears especially useful for bilateral nephrectomy, since many access ports can be spared. We describe 5 cases of simultaneous bilateral radical nephrectomies performed at a single academic institution. We had no intraoperative complications and a mean operating time of 155 minutes. Four patients could be resected using this approach; one case was converted to a traditional laparoscopy. One case had a postoperative complication. We believe this technique is feasible, and can be accomplished with acceptable morbidity and adequate operative time.
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    Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP)
    (2023) Calvo, Carlos Ignacio; Bravo, Juan Cristobal; Navarro, Renato; Canas, Rodrigo; Pasten, Felipe; Francisco, Ignacio F. San
    Purpose: Inguinal hernias and benign prostatic hyperplasia (BPH) can coexist in about one fifth of patients under-going BPH surgery. There is scarce evidence about performing laser enucleation along with open inguinal hernia repair. Our goal is to describe the perioperative outcomes of performing both surgeries in the same operating ses-sion compared to doing HoLEP alone.Materials and Methods: A retrospective analysis of patients undergoing HoLEP and hernioplasty with mesh in the same anesthetic time (group B) at an academic center was conducted. They were compared to a randomly picked control group of patients submitted to HoLEP alone (group A). Preoperative, operative, and postoperative features were compared among both groups.Results: 107 patients submitted to HoLEP alone were compared to 29 combined approach patients (HoLEP + hernia repair). Patients in group A were found to be older and had larger prostates. Group B showed a significantly longer operative time. Length of stay and duration of catheter was comparable among groups. In multivariate anal-ysis, the combined approach was not associated with a higher complication rate.Conclusion: Performing benign prostatic hyperplasia surgery with HoLEP in conjunction with open inguinal hernioplasty is not related to a higher length of stay or a significantly increased risk of morbidity.
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    Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?
    (2021) Santis-Moya, Fernanda; Calvo, Carlos Ignacio; Rojas, Tania; Dell'Oro, Arturo; Baquedano, Paulina; Saavedra, Alvaro
    Aim The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms.