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1.
Medisan ; 26(4)jul.-ago. 2022. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1405824

RESUMO

Introducción: La hiperplasia prostática benigna es una enfermedad frecuente que aumenta su incidencia con la edad. Su patogenia no está clara aún y su cuadro clínico típico es la obstrucción urinaria progresiva con pérdida de calidad de vida. Objetivos: Evaluar el valor predictivo de la flujometría manual en la definición de la conducta terapéutica en pacientes con hiperplasia prostática benigna y determinar la evolución de dichos pacientes en el tiempo. Método: Se realizó un estudio descriptivo, prospectivo y longitudinal de 50 pacientes, diagnosticados como portadores de hiperplasia prostática benigna, desde los puntos de vista clínico e imagenológico, atendidos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2017 hasta igual periodo del 2019. Resultados: La flujometría manual realizada al inicio demostró que 62,0 % de la muestra tenía una tasa de flujo urinario promedio por debajo del rango fisiológico y 22,0 % se encontraba en rango limítrofe o dudoso. Recibieron tratamiento quirúrgico 37 pacientes (74,0 %); 13 (26,0 %) fueron medicados y con seguimiento clínico. Se realizó la resección transuretral de la próstata con una rápida recuperación de los pacientes y en solo 2,0 % hubo complicaciones. Conclusiones: La flujometría manual resultó útil para determinar la conducta a seguir en la mayoría de los pacientes estudiados y en el seguimiento a corto plazo de quienes fueron operados.


Introduction: The benign prostatic hyperplasia is a frequent disease that increases its incidence with the age. Its pathogenesis is not still clear and its typical clinical pattern is the progressive urinary obstruction with loss of life quality. Objectives: To evaluate the predictive value of manual flowmetry in the definition of the therapeutic behavior in patients with benign prostatic hyperplasia and to determine the evolution of these patients as time goes by. Method: A descriptive, prospective and longitudinal study of 50 patients diagnosed with benign prostatic hyperplasia was carried out, from the clinical and imaging points of view, who were assisted in Saturnino Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2017 to the same period in 2019. Results: The manual flowmetry carried out demonstrated at the beginning that 62.0 % of the sample had a rate of average urinary flow below the physiologic range and 22.0 % was in bordering or doubtful range. Thirty seven patients received surgical treatment (74.0 %); thirteen patients (26.0 %) received medication and with clinical follow up. The transurethral resection of prostate was carried out with a quick recovery of the patients and there were complications just in a 2.0 %. Conclusions: The manual flowmetry was useful to determine what to do in most of the studied patients and in the short term follow up of those who were operated.


Assuntos
Hiperplasia Prostática , Reologia , Ressecção Transuretral da Próstata
2.
urol. colomb. (Bogotá. En línea) ; 31(1): 41-42, 15/03/2022.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1368852

RESUMO

Los agentes antifibrinolíticos, como el ácido tranexámico, por medio de su administración endovenosa se usan en distintos procedimientos quirúrgicos para prevenir la pérdida de sangrado perioperatorio.[1] Este medicamento es un derivado sintético análogo de la lisina que bloquea los sititos de unión de la lisina en el plasminógeno, inhibiendo su conversión a plasmina e interfiriendo en la fibrinólisis.[2] La aplicación del ácido tranexámico para disminuir el riesgo de sangrado ha sido utilizado en procedimientos urológicos como la resección transuretral prostática (RTUP), prostatectomía radical y nefrolitotomía percutánea (NLP),[3] [4] [5] también se emplea para disminuir las hematurias persistentes en pacientes con poliquistosis renal y en otras hematurias macroscópicas de origen urológico.


Antifibrinolytic agents, such as tranexamic acid, by intravenous administration are used in various surgical procedures to prevent perioperative bleeding loss.[1] This drug is a synthetic lysine analog derivative that blocks the lysine binding sites on plasminogen, inhibiting its conversion to plasmin and interfering with fibrinolysis.[2] The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and nephrolithotomy. The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and percutaneous nephrolithotomy (PNL),[3] [4] [5] it is also used to reduce persistent hematuria in patients with polycystic kidney disease and other macroscopic hematuria of urological origin.


Assuntos
Humanos , Masculino , Plasminogênio , Procedimentos Cirúrgicos Operatórios , Fibrinolisina , Ressecção Transuretral da Próstata , Nefrolitotomia Percutânea , Antifibrinolíticos , Prostatectomia , Ácido Tranexâmico , Preparações Farmacêuticas , Administração Intravenosa , Doenças Renais Policísticas , Lisina
3.
Int. braz. j. urol ; 48(1): 200-201, Jan.-Feb. 2022.
Artigo em Inglês | LILACS | ID: biblio-1356299

RESUMO

ABSTRACT Purpose: The expansion of technology is leading to a paradigm shift in several urological fields (1, 2). In particular, the adoption of lasers within the surgical treatment of patients with benign prostatic hyperplasia (BPH) is considered one of the most relevant innovations (3-5). In this video, we aimed to report our experience with holmium laser for the ablation of the prostate (HoLAP) in patients with obstructive lower urinary tract symptoms (LUTS) due to BPH. Materials and Methods: From 2018 to 2020, 10 patients with obstructive LUTS secondary to BPH were treated at our Institution with HoLAP (120W Holmium laser Lumenis® with Moses® technology). Main inclusion criteria were: 1) International Prostate Symptom Score ≥12; 2) prostate volume ≤65mL, 3) maximal flow rate (Qmax) ≤15ml/s at preoperative non-invasive uroflowmetry. Results: Mean patient age was 65 (range: 59-72) years. Preoperative mean prostate volume was 50 (range: 35-65) mL. Mean operative time was 66 (range: 45-85) minutes with a mean laser time/operative time ratio of 0.51 (range: 0.44-0.60). Voiding symptoms, Qmax and post voiding residual were significantly improved after 3 and 12 months (all p <0.05). No postoperative urinary incontinence was detected. Conclusions: The present findings suggest that HoLAP is a slightly time-spending procedure, thus its use should be limited to prostate volume <70-80mL. However, no postoperative complications were recorded at all. This technique showed to be a safe option in patients with low-intermediate prostate volume, also in patients whose antiaggregant/anticoagulant therapy is maintained.


Assuntos
Humanos , Masculino , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Próstata/cirurgia , Prostatectomia , Tecnologia , Hólmio
4.
Rev. Assoc. Med. Bras. (1992) ; 68(1): 50-55, Jan. 2022. tab
Artigo em Inglês | LILACS | ID: biblio-1360703

RESUMO

SUMMARY OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.


Assuntos
Humanos , Masculino , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , Estreitamento Uretral/cirurgia , Estreitamento Uretral/etiologia , Ressecção Transuretral da Próstata/efeitos adversos , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Int. braz. j. urol ; 47(1): 131-144, Jan.-Feb. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1134328

RESUMO

ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.


Assuntos
Humanos , Masculino , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Qualidade de Vida , Estudos Prospectivos , Resultado do Tratamento
7.
Rev Chil Anest ; 50(4): 613-616, 2021. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1526456

RESUMO

The Erector Spinae Plane (ESP) block, described in 2016 by Dr. Forero et al, was used to treat neuropathic pain and postoperative acute pain. It was described as an interfascial block in the erector spinae plane, where it manages to block both ventral and dorsal branches of the spinal nerve. Due to scarce literature on its applicability in urological endoscopic surgeries, we formulate the hypothesis that it would be an effective opioid-sparing analgesic alternative in patients undergoing TULIP. Therefore, bilateral ESP was performed in a 69-year-old patient, who underwent transurethral prostatectomy guided by laser induced (TULIP) for benign prostatic hyperplasia. The patient did not require rescue medication, reported a maximum VAS of 4/10. At 72 hours postoperatively, the patient kept a VAS of 0/10, without nausea and vomiting, with a Likert satisfaction level of 1


El bloqueo del plano erector de la espina (ESP) fue descrito en 2016 por el Dr. Forero et al., con el afán de tratar el dolor neuropático y el dolor agudo posoperatorio. Consiste en un bloqueo interfascial en el plano del erector de la espina, en el cual se logra el bloqueo tanto de ramas ventrales como dorsales de los nervios espinales. Debido a la falta de literatura sobre su indicación en cirugías endoscópicas urológicas se formula la hipótesis de que podría considerarse como una alternativa analgésica efectiva ahorradora de opioides en pacientes sometidos a RTU-P. Por lo anterior se realizó el bloqueo ESP de manera bilateral a un paciente de 69 años, el cual fue sometido a prostatectomía transuretral guiado por láser inducido (TULIP) por hiperplasia prostática benigna. El paciente no requirió opioides de rescate, con EVA 0/10 en posoperatorio, valor que se mantuvo de la misma manera por 72 h, tanto en reposo como en movimiento, sin la presencia de náuseas o vómitos y una escala de satisfacción de Likert de 1.


Assuntos
Humanos , Masculino , Idoso , Ressecção Transuretral da Próstata/métodos , Músculos Paraespinais , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Medição da Dor
9.
Int. braz. j. urol ; 46(4): 624-631, 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1134194

RESUMO

ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.


Assuntos
Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Hiperplasia Prostática/cirurgia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária por Estresse/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ressecção Transuretral da Próstata , Terapia a Laser , Lasers de Estado Sólido/efeitos adversos , Cirurgiões , Pessoa de Meia-Idade
10.
Int. braz. j. urol ; 46(4): 575-584, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1134201

RESUMO

ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.


Assuntos
Humanos , Masculino , Idoso , Ressecção Transuretral da Próstata , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/tratamento farmacológico , Fatores de Risco , Resultado do Tratamento , Succinato de Solifenacina/uso terapêutico , Pessoa de Meia-Idade
11.
Iatreia ; 32(2): 102-112, ene.-jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1002144

RESUMO

RESUMEN Introducción: la resección transuretral de próstata (RTUP), independiente de si es con equipo monopolar o bipolar (RTUP-B), es la cirugía estándar en el manejo quirúrgico de los síntomas del tracto urinario inferior (STUI) o de las complicaciones derivadas de la obstrucción por hiperplasia prostática benigna (HPB). Objetivo: revisar la literatura sobre frecuencia y factores de riesgo para complicaciones de la RTUP con bipolar. Resultados: se hizo una revisión de la literatura mediante la búsqueda en Medline desde 1996 hasta 2017. De 76 artículos revisados, 50 se incluyeron. Estos reportan que la RTUP-B ofrece buenos resultados a largo plazo. Las complicaciones en su mayoría son grado I según la clasificación de Clavien-Dindo y las más frecuentes son la eyaculación retrógrada, hematuria secundaria, retención o infección urinaria y estrechez uretral o contractura del cuello vesical. Los factores de riesgo fueron comorbilidades, gravedad de la enfermedad al momento de la intervención, técnica y habilidad del cirujano, entre otros. Discusión: aunque la mayoría de las complicaciones secundarias a la RTUP-B son leves, definir el momento óptimo para la realización de la cirugía e intervenir los factores de riesgo modificables, podría contribuir a mejorar los resultados de esta técnica quirúrgica.


SUMMARY Introduction: Regardless of the technique used, either bipolar or monopolar, transurethral resection of the prostate (TURP) is considered the cornerstone of surgical management for low urinary tract symptoms (LUTS), and benign prostatic obstruction (BPO). Objective: To review the available literature regarding the frequency of bipolar TURP (B-TURP) complications and the risk factor associated with them. Results: The search was conducted using Medline and studies addressing the research question published between 1996 and 2017 were retrieved. Seventy six article were screened and 50 were included. Those papers reported that B-TURP was associates with good long-term outcomes. According to Clavien-Dindo classification, a high proportion of complications were grade I, and the most frequent ones were: retrograde ejaculation, urine retention, urinary tract infection, bleeding and urethral stricture. Risk factors most commonly associated with these complications were: patient's medical status before surgery, the extent of disease at the time of the procedure, skills and technique of the surgeon, amongst other. Discussion: The majority of the surgical complications associated with B-TURP are mild, and identifying the best moment to conduct the procedure and intervening on modifiable risk factors before surgery, may contribute to improve outcomes of the B-TURP.


Assuntos
Ressecção Transuretral da Próstata , Complicações Pós-Operatórias , Complicações Intraoperatórias
12.
VozAndes ; 30(2): 27-33, 2019.
Artigo em Espanhol | LILACS | ID: biblio-1050570

RESUMO

La resolución quirúrgica de la hiperplasia prostática benigna se modifca conforme el acceso a las diferentes tecnologías en salud. Las complicaciones del abordaje endoscópico versus el convencional son similares. El Objetivo de este estudio fue analizar retrospectivamente los resultados de la cirugía convencional y la resección endoscópica monopolar de la hiperplasia de próstata en un hospital terciario del Ecuador. Pacientes y Métodos: Estudio retrospectivo, analítico. Fueron incluidos en el estudio 232 pacientes con diagnóstico histopatológico de hiperplasia prostática benigna atendidos en el servicio de urología del hospital Luis Vernaza en el período enero 2015 ­ diciembre 2016. Los pacientes fueron divididos en 2 subgrupos de acuerdo con el abordaje terapéutico ­ quirúrgico: prostatectomía convencional (n = 120) y resección endoscópica (n = 112). Resultados: Mediante estadística inferencial se comprobó una relación estadísticamente signifcativa entre el tipo de abordaje terapéutico con el tiempo quirúrgico (p= <0.001) y con el índice de sangrado (p= <0.001) y entre la edad y el tiempo quirúrgico (p= <0.001). Las complicaciones más importantes fueron: hemorragia inmediata (n=9) e infecciones de la herida (n=10) para la cirugía convencional y hemorragia inmediata (n=2) y sepsis (n=3) para la cirugía endoscópica. La media de tiempo quirúrgico fue 103.03 min y 75.14 min respectivamente. Conclusión: El desarrollo tecnológico ha traído la certeza de que la cirugía endoscópica tiene menores complicaciones, disminuye los tiempos quirúrgicos. Siendo una opción por considerar frente a la cirugía tradicional para la hiperplasia de próstata


Surgical resolution of benign prostatic hyperplasia is modifed as access to different health technologies. Complications of endoscopic versus conventional approach are similar. The objective of this study was to retrospectively analyze the results of conventional surgery and monopolistic endoscopic resection of prostate hyperplasia in a tertiary hospital in Ecuador. Patients and Methods: Retrospective, analytical study. 232 patients diagnosed with benign prostatic hyperplasia were included in the study in the urology service of the Luis Vernaza hospital in the period January 2015 ­ December 2016. Patients were divided into 2 subgroups according to the therapeutic­surgical approach: conventional prostatectomy (n.120) and endoscopic resection (n. 112). Results: By inferential statistics, a statistically signifcant relationship was found between the type of therapeutic approach with the surgical time (p. 0.001) and with the bleeding index (p. 0.001) and between age and surgical time (p. 0.001). The most important complications were: immediate bleeding (n-9) and wound infections (no. 10) for conventional surgery and immediate bleeding (n-2) and sepsis (no. 3) for endoscopic surgery. The surgical mean time was 103.03 min and 75.14 min respectively. Conclusions: Technological development has brought the certainty that endoscopic surgery has fewer complications, decreases surgical times. Being an option to consider against traditional prostate hyperplasia surgery


Assuntos
Humanos , Masculino , Feminino , Próstata , Prostatectomia , Hematúria , Fístula Urinária , Ressecção Transuretral da Próstata
13.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1401065

RESUMO

Introducción y Objetivos El cáncer de próstata es la segunda causa de mortalidad por cáncer en hombres en Colombia y en el mundo. El efecto "vanishing" en cáncer de próstata, es un fenómeno poco frecuente que se define como la ausencia de tumor en el estudio histológico postquirúrgico de pacientes llevados a prostatectomía radical como manejo curativo diagnóstico previo confirmado por biopsia o RTUP. Su incidencia en diferentes series llega hasta el 0,86%, por lo cual existen pocos estudios aleatorizados al respecto y aún no es clara la conducta con ese tipo de tumores. Reportamos un caso de un paciente con cáncer de próstata pT0 y realizamos una revisión de la literatura respecto del seguimiento y manejo que se deberían seguir al enfrentarnos a ese tipo de tumor. Métodos y Materiales Revisión de la literatura y reporte de caso clínico. Reporte de Caso Hombre de 58 años sintomático urinario, con PSA elevado por lo que se realizó biopsia transrectal de próstata, con resultado de adenocarcinoma de próstata confirmado por inmunohistoquímica. Al realizarse la prostatectomía radical no se encuentra tumor en la patología. En la literatura se encuentran factores asociados con la presencia del tumor cuando hay RTUP previa y uso de hormonoterapia neoadyuvante en el contexto de tumores de bajo volumen. A pesar de no encontrarse tumor en la patología, está descrita la recaída bioquímica y progresión clínica de esos tumores, por lo que debe realizarse el seguimiento usual para esa patología. Conclusiones El hallazgo de pT0 en cáncer de próstata, aunque poco frecuente, demanda una guía de manejo Proponemos la revisión de la patología con el protocolo descrito para reducir los falsos positivos y el seguimiento usual con los pasos estandarizados en las guías internacionales.


Introduction and Objectives Prostate cancer is the second leading cause of death related with cancer in men in Colombia and the world. "Vanishing" phenomenon in prostate cáncer is a rare event, where the post-surgical histologic review in patiets that underwent radical prostatectomy is negative, all of them with previous diagnosis of CaP by biopsy or TUR. The incidence of CaP in different series reaches 0.86%, whereby there are few randomized studies and the management and follow up of this type of tumors is not clear. In this article we report a case of a pT0 prostate cancer patient. We perform a systematic review of the literature to determine the medical behavior and medical follow up in cases presenting with pT0 prostate cancer. Materials and Methods Review of the literature & case report. Results Patient of 58 years old with medical history of recent progressive LUTS and high PSA levels that underwent a trans-rectal prostate biopsy with report of adenocarcinoma, that were confirmed by immunohistochemistry. In the pathology report after the radical prostatectomy no tumor cells were found. In the literature, there is reference about factors associated with pT0 prostate cancer in patients with previous RTUP and that were taken to hormonal coadjutant therapy in lesser degree tumors. Despite the absent of cancer findings in the pathology, it is well described biochemistry relapses and clinical progression of this tumors; usual protocol follow up must be made. Conclusion In patients with pT0 prostate cancer, even though to be a rare finding, must be studied and follow up with the steps mentioned above with the aim to reduce the false positive cases. Also the follow-ups steps must fully meet the requirements of standardized protocols guidelines.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata , Guias como Assunto , Ressecção Transuretral da Próstata , Patologia , Biópsia , Imuno-Histoquímica , Adenocarcinoma , Causas de Morte , Neoplasias Hormônio-Dependentes
14.
urol. colomb. (Bogotá. En línea) ; 28(4): 275-278, 2019. ilus, tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1402574

RESUMO

Objetivos Caracterizar una serie de pacientes con abscesos prostáticos tratados con resección transuretral de próstata, analizar los factores de riesgo, y los resultados del tratamiento. Métodos Se realizó un estudio retrospectivo de 2015 a 2016 en 2 hospitales de III y IV nivel en la ciudad de Bogotá en pacientes con diagnóstico tomográfico de absceso prostático, tratados con resección transuretral de próstata. Resultados Se documentaron 6 casos de hombres diagnosticados con absceso prostático con edad promedio de 57 años (40-78 años) que fueron llevados a RTUP para el drenaje del absceso. El promedio de hospitalización fue de 11.4 días (3-34 días); el aislamiento microbiológico positivo se alcanzó en el 83% de los pacientes. El 50% de los pacientes usaban sonda uretral a permanencia. La curación fue completa. Conclusiones La RTU de próstata en el drenaje de abscesos prostáticos, es un tratamiento seguro y eficaz en logrando resolución completa de la enfermedad.


Objectives To characterize patients with prostate abscesses treated with transurethral resection of the prostate, analyze risk factors, and treatment outcomes. Methods A retrospective study was conducted from 2015 to 2016 in 2 hospitals of III and IV level in the city of Bogotá in patients with tomographic diagnosis of prostate abscess, treated with transurethral resection of the prostate. Results Six cases of men diagnosed with prostate abscess with an average age of 57 years (40­78 years) who were taken to TURP for drainage of the abscess were documented. The average hospitalization was 11.4 days (3­34 days); Positive microbiological isolation was achieved in 83% of patients. 50% of patients used a urethral catheter permanently. The healing was complete. Conclusions The Transurethral resection of the prostate is a safe and effective intervention in achieving complete resolution and drainage of prostatic abscesses.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Ressecção Transuretral da Próstata , Abscesso , Cateteres Urinários , Próstata , Terapêutica , Cura em Homeopatia , Estudos Retrospectivos
15.
Oncología (Guayaquil) ; 28(3): 202-209, 30 de Diciembre 2018.
Artigo em Espanhol | LILACS | ID: biblio-1000326

RESUMO

Introducción: El cáncer de próstata es una neoplasia en la cual la comunicación y el conocimiento de la población puede ayudar al diagnóstico temprano y tratamiento temprano. El objetivo de este estudio fue investigar que conocen los pacientes y acompañantes sobre los procesos de comunicación educativa para la salud en cáncer de próstata. Métodos: El presente estudio descriptivo, fue realizado en el Instituto Oncológico Nacional "Dr Juan Tanca Marengo" Solca-Guayaquil. Se utilizó una encuesta de salud sobre el conocimiento de la entidad nosológica, el conocimiento de los métodos diagnósticos y la predisposición a acudir a charlas educativas. La muestra fue calculada en 80 encuestas a familiares, acompañantes y pacientes del Instituto. Resultados: Se registraron 80 encuestas. Sobre el cáncer de próstata el 52.5 % de los encuestados declara no tener conocimiento alguno sobre el mismo, un 31.25 % asegura tener poco conocimiento sobre el cáncer de próstata, y el 16.25 % declara tener un conocimiento apropiado sobre el cáncer de próstata. Sobre el diagnóstico de Cáncer de Próstata el 58.75 % de los encuestados no sabe cómo se diagnostica, un 22.5% % está informado someramente y un 18.75 % tiene conocimiento del diagnóstico. Conclusión: En este reporte se evidencia el desconocimiento sobre cáncer de próstata que tienen los encuestados sobre su concepto y diagnóstico


Introduction: Prostate cancer is a neoplasm in which communication and knowledge of the population can help early diagnosis and early treatment. The objective of this study was to investigate what patients and companions know about the processes of educational communication for health in prostate cancer. Methods: The present descriptive study was carried out in the National Drugs Institute "Dr Juan Tanca Marengo" Solca-Guayaquil. A health survey was used on the knowledge of the nosological entity, the knowledge of the diagnostic methods and the predisposition to attend educational talks. The sample was calculated in 80 surveys to relatives, companions and patients of the Institute. Results: 80 surveys were registered. Regarding prostate cancer, 52.5% of the respondents declare to have no knowledge about it, 31.25% claim to have little knowledge about prostate cancer, and 16.25% declare to have an appropriate knowledge about prostate cancer. About the diagnosis of Prostate Cancer, 58.75% of respondents do not know how it is diagnosed, 22.5%% is briefly informed and 18.75% have knowledge of the diagnosis. Conclusion: This report shows the lack of knowledge about prostate cancer that respondents have about their concept and diagnosis.


Assuntos
Humanos , Neoplasias da Próstata , Comunicação , Masculinidade , Razão de Masculinidade , Ressecção Transuretral da Próstata , Educação
16.
São Paulo med. j ; 136(5): 484-487, Sept.-Oct. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-979373

RESUMO

ABSTRACT CONTEXT: Inflammatory myofibroblastic tumors are a rare type of soft-tissue tumor. Inflammatory myofibroblastic tumors are characterized by rearrangements involving the anaplastic lymphoma kinase gene locus on 2p23. Case Report: We report the case of a 67-year-old Chinese male who presented with dysuria and fever. Magnetic resonance imaging showed an irregular prostatic mass with an isointense signal and obscure boundary. Histopathological evaluation showed that the mass consisted mainly of spindle-shaped cells. Immunohistochemical evaluation showed that the tumor cells were negative for anaplastic lymphoma kinase. CONCLUSIONS: Inflammatory myofibroblastic prostate tumors are rare lesions with unclear etiology. The pathological diagnosis is very important.


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Próstata/enzimologia , Neoplasias da Próstata/patologia , Neoplasias de Tecidos Moles/enzimologia , Neoplasias de Tecidos Moles/patologia , Quinase do Linfoma Anaplásico/análise , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Biópsia , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Ressecção Transuretral da Próstata
17.
Rev. bras. anestesiol ; 68(4): 388-391, July-Aug. 2018.
Artigo em Inglês | LILACS | ID: biblio-958317

RESUMO

Abstract We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4 hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered completely over the next few days without any residual neurological deficit.


Resumo Relatamos o caso de um paciente hipertenso, 72 anos, que desenvolveu hipertensão grave seguida de deterioração neurológica no pós-operatório imediato após ressecção transuretral de próstata. Embora os testes laboratoriais e a gasometria tenham excluído a síndrome de ressecção transuretral de próstata ou qualquer outra causa metabólica, a diminuição da pressão sanguínea não conseguiu melhorar os sintomas. Uma tomografia computadorizada craniana, realizada 4 horas após o aparecimento de sintomas neurológicos, revelou infartos gangliocapsular bilateral e talâmico à direita. AAS oral foi aconselhado para prevenir um acidente vascular cerebral recorrente precoce. O tratamento de apoio e a ventilação mecânica garantiram a estabilidade fisiológica e o paciente obteve recuperação completa durante os próximos dias, sem qualquer déficit neurológico residual.


Assuntos
Humanos , Masculino , Idoso , Acidente Vascular Cerebral/etiologia , Ressecção Transuretral da Próstata/instrumentação , Período Perioperatório , Hipertensão/etiologia , Respiração Artificial
18.
Clinics ; 73: e264, 2018. tab
Artigo em Inglês | LILACS | ID: biblio-890740

RESUMO

OBJECTIVES: To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS: We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS: Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS: This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperplasia Prostática/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Ressecção Transuretral da Próstata/efeitos adversos , Inibidores de 5-alfa Redutase/uso terapêutico , Fatores de Tempo , Transfusão de Sangue , Cuidados Pré-Operatórios/métodos , Modelos Logísticos , Fatores de Risco , Estudos de Coortes , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Serviço Hospitalar de Emergência , Hematúria/etiologia , Hematúria/prevenção & controle
19.
Medwave ; 18(1): e7134, 2018.
Artigo em Inglês, Espanhol | LILACS | ID: biblio-909743

RESUMO

INTRODUCCIÓN: La resección transuretral es el método de elección para la resolución endoscópica de la uropatía obstructiva baja por hiperplasia benigna de la próstata menor a 80cc. Tradicionalmente esta ha sido realizada con asas de resección que utilizan energía monopolar. El uso de energía bipolar ha desplazado la tecnología precedente en el último tiempo. Se dispone a evaluar la eficacia y seguridad de ambas tecnologías para la técnica. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyen 32 estudios primarios, de los cuales 31 corresponden a ensayos aleatorizados. Concluimos que, si bien podrían no existir diferencias de eficacia entre ambas técnicas, la utilización de energía bipolar disminuye la incidencia de síndrome post resección transuretral y probablemente disminuye el riesgo de sangrado que requiere transfusión.


INTRODUCTION: Transurethral resection is currently considered as standard endoscopic treatment for lower urinary tract obstruction due to benign hyperplasia under 80 cc. Monopolar resection loops has been traditionally used but bipolar energy has recently displaced precedent technology. The purpose of this summary is to evaluate the efficacy and safety of both technologies. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews including 32 primary studies, among them 31 randomized trials. We concluded although there may be no difference in terms of efficacy among both techniques, the use of bipolar energy reduces the incidence of transurethral resection syndrome and probably reduces the risk of bleeding that requires red blood cell transfusion.


Assuntos
Humanos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Sintomas do Trato Urinário Inferior/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Perda Sanguínea Cirúrgica/prevenção & controle , Bases de Dados Factuais , Resultado do Tratamento
20.
Rev. medica electron ; 39(3): 495-506, may.-jun. 2017.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-902189

RESUMO

Introducción: en la actualidad se han descrito diversos modelos de raquianestesia con bupivacaína a dosis diferentes, asociadas o no con fentanilo, que proveen de una anestesia segura y eficaz, disminuyen la intensidad de dolor posquirúrgico, preservan la función cognoscitiva, y reduce las complicaciones atribuidas a la lidocaína hiperbárica por neurotoxicidad. Objetivo: evaluar el efecto de bajas dosis de bupivacaína con fentanilo para anestesia subaracnoidea en pacientes sometidos a resección transuretral de próstata. Materiales y Métodos: se realizó un estudio descriptivo cuantitativo, longitudinal, prospectivo en 200 pacientes programados para dicha cirugía e indicación de anestesia subaracnoidea con bupivacaína, los cuales fueron distribuidos de forma aleatoria en cuatro grupo. Resultados: tanto el bloqueo sensitivo como motor fue más rápido en los pacientes de los Grupos B (3,0; 11,2) y (7,1; 8,3), Grupo C (5,0; 9,4) y (6,2; 9,4) y Grupo D (6,1; 8,3) y (4,7; 10,9); mientras que el Grupo A fue de (6,0; 8,5) y (9,9; 11,7), respectivamente. Se observó que en la totalidad de los pacientes de los Grupos C y D se obtuvo anestesia de buena calidad. Conclusiones: la administración intratecal de 7,5 mg de bupivacaina con 25 µg de fentanilo produjo anestesia satisfactoria, disminuyó el periodo de latencia, mantuvo mejor estabilidad hemodinámica, prolongó la analgesia postoperatoria y se asoció a menor incidencia de complicaciones peri operatorias (AU).


Introduction: currently, several models of spinal anesthesia with bupivacaine in different doses, associated or not to fentanyl, have been described providing a safe and efficacious anesthesia, reducing the intensity of the postsurgical pain, preserving the cognitive function, and reducing the complications attributed to hyperbaric lidocaine due to its neurotoxicity. Aim: to assess the effect of low doses of bupivacaine with fentanyl as subarachnoid anesthesia in patients undergoing a prostate trans-urethral resection. Materials and Methods: a prospective, longitudinal, quantitative, descriptive study was carried out in 200 patients programmed for that kind of surgery and with the indication of subarachnoid anesthesia through bupivacaine; they were randomly distributed in four groups. Outcomes: both, the sensory block and the motor one were faster in the patients of the Group B (3,0; 11,2) and (7,1; 8,3), Group C (5,0; 9,4) and (6,2; 9,4) and Group D (6,1; 8,3) and (4,7; 10,9); while in the patients of the Group A they were (6,0; 8,5) y (9,9; 11,7) respectively. It was observed a good quality anesthesia in all the patients of the Groups C and D. Conclusions: the intrathecal administration of 7,5 mg of bupivacaine with 25 µg of fentanyl produced a satisfactory anesthesia, reduced the latency period, kept a better hemodynamic stability up, extended the post-surgery analgesia and was associated to fewer incidences of perioperative complications (AU).


Assuntos
Humanos , Masculino , Feminino , Bupivacaína/uso terapêutico , Fentanila/uso terapêutico , Raquianestesia/métodos , Ressecção Transuretral da Próstata/métodos , Estudos Observacionais como Assunto , Anestesia Local/métodos
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