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Introduction and Objectives: Advances in assisted reproductive techniques (ART) have caused an increase in requests for postmortem sperm retrieval (PMER). The use of these techniques is usually tied to legal, ethical and medical/casuistic problems. The objective of this work is to analyze technical and legal aspects of PMER in Spain using two real cases and to establish guidelines to help in decision-making after a PMER request., Material and Methods: Two real cases in which a PMER was requested and others published in Spain in recent years are presented. We proceed to an exposition of the techniques used in postmortem ART cases and specifically in PMER, and a detailed study of the current legal framework is carried out., Results: In Spain we have a complete law on ART. Article 9 expressly requires an authorization from the deceased male partner for the use of his reproductive material in the following 12 months. Regarding the PMER, technical and logistical considerations require a quick and organized decision-making. The time until extraction should not exceed 24-36hours from death and a good choice of biological material is essential., Conclusions: Medical-scientific advances now allow PMER and the use of postmortem ART. A good knowledge of the technical, logistical and legal aspects is necessary for a fast and coordinated action., (Copyright © 2022 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital., Methods: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1 st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019., Results: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003)., Conclusions: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group., (Copyright © 2021 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in real-life practice and investigate the factors influencing the safety and effectiveness of the technique., Patients and Methods: Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP over 10 years of routine practice in three hospitals. Analysed variables included: preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. prostate-specific antigen (PSA) level, maximum urinary flow rate [Q max ], and International Prostate Symptom Score [IPSS]), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early postoperative outcomes (change in blood parameters, catheterisation time, and hospital stay), and 12-month follow-up outcomes (change in IPSS, PSA level, and Q max )., Results: The analysis included 963 patients, aged 48-91 years, with a mean (range) prostate size of 91 (35-247) mL. The mean (sd) operation time was 77 (29) min, and the hospital stay and catheterisation time were 4 (2) and 1.3 (2) days, respectively. In all, 56 patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or transurethral resection of the prostate due to intraoperative complications. Patients had a significant decrease in haemoglobin and haematocrit, but no differences were seen between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and <100 mL. The concomitant removal of bladder calculi and having a prostate ≥100 mL resulted in a longer operation time, but did not influence the safety and effectiveness outcomes., Conclusions: HoLEP is suitable for real-life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, bladder lithiasis or a prostate ≥100 mL., (© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.)

Purpose: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times., Materials and Methods: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain., Results: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic.

Objectives: The pandemic caused by the new SARS / Cov-2 Coronavirus represents an unprecedented scenario in modern medicine that affects many aspects of daily healthcare. Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has a high prevalence and is related to high consumption of health resources. For this reason, we performed a revision of the management of LUTS and HBP during and after COVID-19 pandemic., Material and Methods: A group of experts in benign prostatic hyperplasia from different regions of Spain were selected to design a strategy to reorganize the management of benign prostatic hyperplasia and lower urinary tract symptoms during the pandemic. A comprehensive review of the literature was undertaken and a set of recommendations are generated., Results: Recommendations for the management of LUTS-BPH during and after the SARS/CoV2 coronavirus pandemic outbreak consist of promoting telemedicine and developing joint protocols with Primary Care Attention .Clear diagnostic and treatment criteria and referral criteria must be established. Referral of patients for risk complications such as kidney failure, recurrent hematuria and obstructive uropathy are a priority. Surgeries due to BPH are generally potentially delayed until phases I and II of the pandemic, in which the percentage of hospitalized patients with COVID-19 does not exceed 25%, and it is necessary to determine COVID19 negativity. The surgical technique that associates the least complications and the shortest stay should be selected., Conclusions: The diagnosis and prescription of treatment for BPH during the COVID-19 pandemic should be based on telemedicine and joint protocols for primary care attention and urology. Elective surgical treatment can be delayed until we are in phases I or II, individualizing the surgical and anaesthetic technique of choice to minimize risks.

Objective: To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI)., Material and Methods: Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression., Results: The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R 2 =.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204)., Conclusions: The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels., (Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To assess the performance of the Brief Sexual Symptom Checklist for men (BSSC-M) questionnaire in General Practitioner's (GP) consults in Spain., Methods: Multicenter, cross-sectional study conducted in Spain among men ≥50 years, visiting a GP for any reason, and being able to answer self-administered questionnaires. Patients receiving medicines for erectile dysfunction (ED) and those with poor functional status were excluded. Sexual satisfaction was assessed by the BSSC-M, ED by the Sexual Health Inventory for Men (SHIM), and quality of life (QoL) using a 5-point Likert scale., Results: In all, 770 men met all the selection criteria and 556 patients (72.2%) reported sexually related problems, ED being the most frequent (n = 427; 55.5%). The SHIM score decreased progressively with the number of causes of sexual dissatisfaction. Prevalence of ED (SHIM ≤21) was greater in patients who referred problems with erection in the BSSC-M questionnaire (76 vs. 14%; p < 0.001). Multivariate analysis for ED prediction revealed that sexual dissatisfaction, QoL (average or low/very low), and the presence of 3 or more comorbidities significantly influenced the chances of having ED., Conclusions: Our results encourage the use of the BSSC-M for identifying suspicion of ED and other sexual problems in patients > 50 who visit their GP for a routine follow-up., (© 2018 S. Karger AG, Basel.)

Objective: To evaluate semen quality of men with proven fertility in Spain over the last 3 decades., Methods: We conduct a retrospective analysis of ejaculate samples of 992 men between 1985 and 2009. All patients had proven fertility as demonstrated by fathering at least 2 children and a semen analysis performed before they underwent vasectomy. A standardized procedure was used for the semen analysis. Semen volume, total sperm count, sperm concentration, motility, and percentage of morphologically normal spermatozoa were assessed. Mean values were calculated by examining microscopic fields of 100 spermatozoa., Results: Statistically significant differences were found in all semen parameters analyzed. For the periods 1985-1990, 1990-2000, and 2000-2009, the mean (standard deviation [SD]) sperm concentration was 27.7 (22.97), 20.73 (14.79), and 20.18 (20.79) × 10(6) (P <.0001). The mean (SD) progressive motility for each period was 53.19 (20.35), 47.22 (15.84), and 40.57 (15.15; P <.0001). The mean (SD) normal-shaped spermatozoa for each period was 67.69 (10.24), 58.87 (14.67), and 51.02 (15.76; P <.0001). Multivariate analysis using a logistic regression model showed that age had no significant effect in the variation of semen parameters at the cut-points analyzed, except for normal forms at percentile 25 (P = .001). Multivariate analysis revealed a trend for decline of semen in sperm concentration, progressive and nonprogressive motility, and the percentage of morphologically normal spermatozoa (P = .001-.002)., Conclusion: Over the last 3 decades, a decline in semen quality was found in all the parameters analyzed in Spanish men with proven fertility., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: The Erection Hardness Score (EHS) is a one-item questionnaire that assesses rigidity on a 4-point scale., Aim: To perform a validation of a Spanish version of the EHS by comparison with the International Index of Erectile Function (IIEF) questionnaire., Methods: Validation of the EHS included: (i) professional translation of the scale; (ii) scientific evaluation of the translation from four independent urologists; (iii) assessment on five individuals to test correct comprehension and idiomatic adequacy (iv) validation of the EHS by a cross-sectional, multicenter comparison with the IIEF., Main Outcome Methods: Patients were required to respond to a Spanish version of the EHS and IIEF. Statistic correlation was carried out between the EHS score and IIEF-erectile function domain (EF) score., Results: A total of 125 patients were recruited. Overall prevalence of erectile dysfunction (ED) by the EHS questionnaire was of 80.2% patients (n=97). Mean EHS was 2.74±0.97. Mean IIEF-EF score was 17.4±9.5. The EHS showed good reliability. The rate of missing responses to the EHS questionnaire was 0%. A one-factor analysis of variance was performed between the EHS and EF subdomain of IIEF (P=0.000). Pearson's correlation coefficient between EHS and EF subdomain of IIEF was 0.834, P<0.01., Conclusions: The EHS is a reliable tool to test ED and its Spanish version was satisfactorily understood by patients and correlated with IIEF-EF., (© 2010 International Society for Sexual Medicine.)

Introduction: Radical nephrectomy has traditionally been considered as the standard treatment for renal tumors. Nephron-sparing surgery was introduced two decades ago. Its excellent oncological and functional results have led to widespread use of this procedure. This procedure was first performed at our institution in 1991. Our experience with open partial nephrectomy is reported., Materials and Methods: Our series of 83 open partial nephrectomies performed from 1991 to date for oncological purposes is analyzed. The demographic, intraoperative, postoperative, oncological, and functional results are reported. A survival analysis and renal function evaluation is also provided., Results: Thirty-four of the 83 open partial nephrectomies (42%) were non-elective. Mean tumor size was 36 mm (12-120). Fifty-two percent of tumors were exophytic and 38% endophytic. The most relevant intraoperative variables included a median surgery time of 160 min, an ischemia time of 15 min, a blood loss of 500 mL, and a 9-day hospital stay. Twenty-four percent of patients experienced complications, of which fistula was the most common, occurring in 6 patients (8.8%). The pathological study revealed clear renal cell carcinoma in 57% of patients and benign tumors in 25%. Stage at diagnosis was pT1A in 61% of patients, pT1B in 27%, pT2 in 3%, and pT3 in 9%. Grade 2 of Furham classification was most common (40%). Positive surgical margins were seen in 4% of patients. Cancer-specific survival rates were 94% at 5 years and 85% at 10 years. A slight increase was seen in median creatinine levels when preoperative and postoperative values were compared: 0.04, 0.11, 0.08, and 0.03 at 6, 12, 24, and 36 months respectively. A minimum, statistically significant increase was found in mean creatinine levels 6, 12, 24, and 36 months after surgery as compared to preoperative values., Conclusions: Open partial nephrectomy is a feasible procedure routinely used in our standard practice. Its oncological results are satisfactory and consistent with those reported in the literature. The procedure also has a low complication rate and an excellent functional outcome, and is therefore the procedure of choice for a wide spectrum of patients when performed by experienced surgeons.