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Asociación entre las trabéculas vesicales severas y la realización de prostatectomía en pacientes con síntomatología urinaria asociada a hiperplasia prostática, atendidos en Uromédica entre los años 2007 y 2017

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dc.contributor.advisorRuíz Steimberg, Jaime Enrique
dc.creatorGaona Morales, José Luis
dc.creatorSánchez León, Hugo Alexander
dc.creator.degreeMagíster en epidemiología
dc.date.accessioned2018-06-06T14:36:30Z
dc.date.available2018-06-06T14:36:30Z
dc.date.created2018-05-18
dc.date.issued2018
dc.descriptionIntroducción: La presencia de trabéculas severas en pacientes con hiperplasia prostática (HPB) y sintomatología urinaria supone un deterioro anatómico y funcional de la pared de la vejiga. Dicho deterioro conlleva a una mayor probabilidad de fracaso en el manejo farmacológico, pero existen pocas investigaciones al respecto. En este estudio, determinamos la asociación entre la presencia de trabéculas severas y el riesgo de prostatectomía en pacientes con HPB. Métodos: En este estudio retrospectivo de supervivencia analizamos las historias clínicas de 234 pacientes con HPB atendidos en Uromédica Ltda. en Bucaramanga, Colombia, quienes fueron manejados médicamente después de una cistoscopia. Las cistoscopias fueron realizadas entre 2007 y 2012, y se registró en cada paciente el tiempo de seguimiento y el hecho de que se haya realizado o no prostatectomía correctiva para su HPB. Se consideraron censurados aquellos pacientes que no fueron intervenidos. Se registraron valores de las siguientes variables independientes: grado de trabéculas, edad, volumen prostático, presencia de lóbulo medio, presencia de hiperplasia del cuello vesical, residuo postmiccional, capacidad vesical. Considerando la cirugía/tiempo de seguimiento como variable dependiente, se hizo un análisis bivariado con cada una de las variables independientes y una regresión de Cox con las variables que fueron significativas en el análisis bivariado. Se evaluaron también diferentes modelos de regresion incluyendo diferentes términos de interacción entre las diferentes variables independientes. Adicionalmente, se analizaron diferentes modelos de regresión para evaluar la existencia de factores confusores de la asociación entre trabéculas vesicales y la variable dependiente. Resultados: La mediana del tiempo de seguimiento fue de 25,1 meses. 81 pacientes (34,6%) fueron intervenidos quirúrgicamente. El análisis bivariado mostró que las variables independientes asociadas con un mayor riesgo de cirugía fueron las trabéculas severas, la edad, el PSA, el lóbulo medio, el residuo postmiccional y el volumen prostático. La supervicencia mediana libre de cirugía fue de 77,4 mees para los pacientes con trabéculas leves y 36,1 meses para los pacientes con trabéculas severas (p<0,001). El análisis multivariado mostró que las únicas variables asociadas al riesgo de cirugía fueron la presencia de trabéculas (p<0,001, HR = 3,83) y el PSA (p=0,002, HR = 1,09). No se encontraron interacciones entre las variables independientes. La única variable independiente que actuó como confusora de la asociación entre las trabéculas y el riesgo de cirugía fue el nivel de PSA. Conclusiones: Existe una asociación entre la presencia de trabéculas vesicales severas y el riesgo de prostatectomía en pacientes con sintomatología urinaria secundaria a HPB.spa
dc.description.abstractIntroduction: The presence of severe trabeculae in patients with prostatic hyperplasia (BPH) and urinary symptomatology supposes an anatomical and functional deterioration of the bladder wall. This deterioration leads to a greater probability of failure in pharmacological management, but there are few investigations in this regard. In this study, we determined the association between the presence of severe trabeculae and the risk of prostatectomy in patients with BPH. Methods: In this retrospective survival study, we analyzed the medical records of 234 patients with BPH attended at Uromédica in Bucaramanga, Colombia, who were medically managed after a cystoscopy. The cystoscopies were performed between 2007 and 2012, and the time of follow-up and the fact of having been operated was recorded in each patient. Those patients who were not operated were considered censored. Values of the following independent variables were recorded: degree of bladder trabeculation, age, prostate volume, presence of middle lobe, presence of bladder neck hyperplasia, postvoid residual, bladder capacity. Considering the surgery / follow-up time as a dependent variable, a bivariate analysis was made with each of the independent variables. A Cox regression was made with the variables that were significant in the bivariate analysis.We made different regression models including interaction between the different independent variables. Additionally, different regression models analyzed the existence of confounding factors of the association between bladder trabeculation and the dependent variable. Results: The median follow-up time was 25.1 months. 81 patients (34.6%) underwent surgery. The bivariate analysis showed that the independent variables associated with an increased risk of surgery are severe trabeculae, age, PSA, middle lobe, postvoid residual and prostatic volume. The median surgery free survival was 77.4 months for patients with mild trabeculae and 36.1 months for patients with severe trabeculae (p <0.001). The multivariate analysis showed that the variables associated with surgery risk were the presence of bladder trabeculation (p <0.001, HR = 3.83) and PSA (p = 0.002, HR = 1.09). No interactions were found between the independent variables. The only independent variable that acted as a confounder of the association between the trabeculae and the risk of surgery was the PSA level. Conclusion: There is an association between the presence of severe bladder trabeculation and the risk of prostatectomy in patients with urinary symptoms secondary to BPH.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_18040
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/18040
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectTrabéculas vesicalesspa
dc.subjectProstatectomíaspa
dc.subjectHiperplasia prostáticaspa
dc.subjectSintomatología urinaria bajaspa
dc.subject.ddcEnfermedades
dc.subject.keywordProstatic hyperplasiaeng
dc.subject.keywordUrinary low symptomatologyeng
dc.subject.keywordBladder trabeculationeng
dc.subject.lembEnfermedades de la próstataspa
dc.subject.lembProstatectomíaspa
dc.titleAsociación entre las trabéculas vesicales severas y la realización de prostatectomía en pacientes con síntomatología urinaria asociada a hiperplasia prostática, atendidos en Uromédica entre los años 2007 y 2017spa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
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