https://hdl.handle.net/10481/59279 Thu, 09 Apr 2026 14:16:54 GMT 2026-04-09T14:16:54Z https://hdl.handle.net/10481/111879 De-Intensification Strategies in Non-Muscle-Invasive Bladder Cancer: Outcomes and Cost Impact of In-Office Bladder Fulguration Melgarejo-Segura, Maria Teresa; Herraez Marcos, Miguel; Cano Garcia, Maria Carmen; Zambudio-Munuera, Alberto; Rodríguez Parras, Patricia; Arrabal Polo, Miguel Ángel Background/Objectives: Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates, requiring frequent diagnostic and therapeutic interventions. This study evaluates the feasibility, safety, oncological outcomes, and economic impact of im plementing an in-office laser bladder tumor fulguration protocol. Methods: A descriptive, longitudinal study was conducted between 2020 and 2025 on 65 patients with recurrent NMIBC. Procedures were performed in an outpatient setting under local anesthesia us ing a flexible cystoscope and a Holmium:YAG (Ho:YAG) laser. The primary endpoint was recurrence-free survival. Secondary endpoints included complication rates (Clavien Dindo) and a cost-analysis comparison with conventional transurethral resection of the bladder (TURBT). Results: The mean age was 69.4 years, with 89.2% of patients classified as ASA≥2. After a median follow-up of 20.3 months, the recurrence rate was 33.8%, with 0% progression. Most procedures (95.4%) had no complications; only 4.6% presented Clavien–Dindo grade 1 events. Adjuvant mitomycin C was administered in 93.8% of cases. The cost analysis demonstrated substantial economic advantages, with costs reduced by 89.7% versus the 24 h admission model and 82.1% versus the day-surgery model according to regional health-system tariffs. Conclusions: In-office laser fulguration is a safe, effective, and economically sustainable alternative to traditional TURBT for selected low-risk recur rences. It optimizes hospital resources, minimizes anesthetic risk in comorbid patients, and maintains favorable oncological control. https://hdl.handle.net/10481/111879 https://hdl.handle.net/10481/110971 Robot-Assisted Radical Prostatectomy Beyond the Learning Curve: Does Prior Laparoscopic Experience Influence Surgical Outcomes? Zambudio-Munuera, Alberto; Millán Ramos, Irene; Rodríguez Parras, Patricia; Gutiérrez-Tejero, Francisco; Melgarejo-Segura, Maria Teresa; Arrabal Martín, Miguel; Arrabal Polo, Miguel Ángel Background/Objectives: Robot-assisted radical prostatectomy (RARP) is widely used in contemporary prostate cancer surgery; however, surgeons enter robotic practice through heterogeneous training pathways. This study aimed to compare early oncological and functional outcomes after RARP between two experienced robotic surgeons with different surgical backgrounds after completion of the learning curve. Methods: We conducted a retrospective, consecutive, single-center study including patients undergoing RARP after completion of the learning curve (> 40 cases) by two experienced robotic surgeons with different surgical backgrounds. Baseline characteristics, perioperative variables, and early oncological and functional outcomes were compared between surgeons. Pentafecta achievement was assessed as an exploratory composite outcome. Appropriate non-parametric and categorical statistical tests were applied as appropriate. Results: Ninety-three patients were included (55 operated on by surgeon A and 38 by surgeon B). Preoperative clinical and pathological characteristics were largely comparable between groups, except for prostate volume. Median operative time was significantly shorter for surgeon A (70 vs. 120 min, p < 0.001). Postoperative morbidity was low, with no major complications and no differences in length of hospital stay. At 6 months, urinary continence and erectile function recovery rates were high and comparable between surgeons. Oncological outcomes, including positive surgical margin rates and biochemical recurrence, did not differ significantly, although recurrence events were infrequent and follow-up was limited. Overall pentafecta achievement was modest and similar between groups (23.6% vs. 21.1%, p = 0.77), with positive surgical margins emerging as the main limiting factor. Conclusions: In this exploratory post-learning curve analysis, early oncological and functional outcomes after RARP were similar between surgeons with different surgical backgrounds. These findings should be interpreted cautiously and considered hypothesis-generating. https://hdl.handle.net/10481/110971 https://hdl.handle.net/10481/110567 Adenosquamous Carcinoma of the Pancreas: Outcomes of a Multicenter European Study (ADESQUPAN Project) Serradilla Martín, Mario Background. Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer. Compared with other pancreatic tumors, ASCP has a notably poorer prognosis and shorter survival rates. The optimal therapeutic approaches to ASCP have yet to be defined. Methods. This retrospective, multicenter European study included all consecutive patients who underwent elective pancreatic surgery for ASCP at participating centers between 2010 and 2024. The inclusion criteria encompassed all patients who underwent scheduled surgery for ASCP during the study period. The exclusion criteria ruled out patients without a confirmed pathologic diagnosis of ASCP, those who did not undergo surgery, and patients with extrapancreatic disease. Results. The study analyzed 194 patients from 29 hospitals in 11 European countries. The overall survival rates were 56.2% at 1 year, 26.3% at 3 years, and 9.8% at 5 years. The disease-free survival rates at the same intervals were 36.6%, 16.5%, and 6.7%, respectively. In the multivariate analysis, significant associations with shorter survival were R2 resections, lymphatic stromal invasion, T4 stage, no adjuvant chemotherapy, and recurrence. Conclusions. Patients who undergo resection for ASCP experience very low 5-year survival rates (10%). It is advisable to avoid resecting T4 tumors in patients with significant comorbidities or R2 resections. Additionally, failure to provide adjuvant chemotherapy, often due to severe postoperative complications, further deteriorates the prognosis. https://hdl.handle.net/10481/110567 https://hdl.handle.net/10481/108853 Prevalence of the endolymphatic sac hypoplasia in a cohort of individuals without Meniere disease Robles Bolívar, Paula; Martínez Martínez, Marta; Martín-Márquez, Rocío; Berrio-Domínguez, Inés; Martín Rodríguez, José Luis; Lopez-Escamez, Jose Antonio Purpose: To estimate the prevalence of endolymphatic sac hypoplasia (EShp)—a proposed specific finding in Menière ´ ’s disease (MD) that defines an endophenotype characterized by bilateral involvement, male predominance, temporal bone abnormalities, and familial clustering—in individuals without MD, to assess its specificity for the condition. Methods: We analyzed 956 temporal bone CT scans from individuals without MD to assess the prevalence of EShp using the Angular Trajectory of the Vestibular Aqueduct (ATVA) marker. ATVA distribution, reproducibility, and associations with clinical variables were also evaluated. Results: EShp was identified in 6 ears from 4 individuals, yielding a prevalence of 0.6% per patient and 0.8% per ear. ATVA values had a median of 95.0° (IQR = 12.5°, range 65.9°–159.4°). Interobserver agreement was good (ICC = 0.75), with a mean bias of 6.2° ± 5.4° and 5.5% of ears outside the 95% limits of agreement. No significant associations were found between ATVA and sex, age, or clinical diagnosis. Conclusions: EShp is rare in individuals without MD, supporting its specificity and potential role in MD pathophysiology. The ATVA marker is reliable and reproducible and may serve as a CT biomarker for the hypoplastic MD endophenotype. https://hdl.handle.net/10481/108853 https://hdl.handle.net/10481/107759 Ultrasound-Guided Localization of the Refill Port for Intrathecal Infusion Pump Recharge: A Systematic Review Lechuga Carrasco, Beatriz; Cordero Tous, Nicolás; Reinoso-Cobo, Andrés; Cortés-Martín, Jonathan; Sánchez-García, Juan Carlos; Rodríguez-Blanque, Raquel; Gálvez Mateos, Rafael Background: Managing pain with intrathecal infusion pumps has significantly improved the treatment of individuals whose pain is uncontrollable by other methods. Using ultrasound to locate the refill port of these infusion pumps may offer an improvement over traditional methods. Objective: The objective of this systematic review is to update existing knowledge on the use of ultrasound for locating the refill port in intrathecal infusion pumps. Methods: The PRISMA review protocol was followed, and the review was registered in PROSPERO under registration number CRD 42024595671. Results: The main findings indicate that this technique is primarily used only in complex cases where access is difficult. Pain assessment, patient satisfaction, and recharge time compared to the traditional method are crucial factors for selecting the type of process to implement. Conclusions: No conclusive data are presented regarding the technique’s effect on pain reduction, patient satisfaction, reduction in time spent refilling the pump, or the prior experience level of the professional performing it, but notable improvements in these aspects are observed in certain situations. https://hdl.handle.net/10481/107759