Lower urinary tract symptoms and obstructive sleep apnea syndrome: Urodynamic evolution before and after one year of treatment with continuous positive airway pressure. / Síntomas de tramo urinario inferior y síndrome de apnea obstructiva del sueño: evolución urodinámica antes y después de un año de tratamiento con presión continua positiva de la vía aérea.

OBJECTIVE: To report the clinical evolution and the urodynamic behaviour of several lower tract urinary symptoms in patients with obstructive sleep apnea syndrome before and after the treatment with continuous positive airway pressure (CPAP) devices. METHODS: A prospective study was performed; patients with recent diagnosis of sleep apnea confirmed by nocturnal sleep polygraphy and absence of medical urological past history. In order to discard important lower urinary tract conditions, urological examinations were previously performed. Urinary symptoms were evaluated using the IPSS and OAB-V8 validated questionnaires, three-day Bladder Diary and invasive urodynamic examinations with a gap of one year before and one year after using the CPAP. RESULTS: 84 urodynamic studies were carried out in 43 patients. The IPSS score decreased by 3.58 points. The OAB-V8 score decreased by 2.87 points. Nocturia episodes decreased to one per night. The percentage of patients with nocturnal polyuria went down to 26%. The bladder compliance significantly increased (97.39 vs 200.40ml/cm H2O). The presence of detrusor overactivity decreased from 11 (before CPAP) to 5 patients (after CPAP). CONCLUSION: The proper treatment with CPAP showed a statistical and clinical improvement of several LUTS with limited urodynamic modifications.

Methodology of a systematic review. / Metodología de una revisión sistemática.

CONTEXT: The objective of evidence-based medicine is to employ the best scientific information available to apply to clinical practice. Understanding and interpreting the scientific evidence involves understanding the available levels of evidence, where systematic reviews and meta-analyses of clinical trials are at the top of the levels-of-evidence pyramid. ACQUISITION OF EVIDENCE: The review process should be well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include (i) correctly formulating the clinical question to answer (PICO), (ii) developing a protocol (inclusion and exclusion criteria), (iii) performing a detailed and broad literature search and (iv) screening the abstracts of the studies identified in the search and subsequently of the selected complete texts (PRISMA). SYNTHESIS OF THE EVIDENCE: Once the studies have been selected, we need to (v) extract the necessary data into a form designed in the protocol to summarise the included studies, (vi) assess the biases of each study, identifying the quality of the available evidence, and (vii) develop tables and text that synthesise the evidence. CONCLUSIONS: A systematic review involves a critical and reproducible summary of the results of the available publications on a particular topic or clinical question. To improve scientific writing, the methodology is shown in a structured manner to implement a systematic review.

[Renal angiomyolipoma in a patient with tuberous sclerosis. Case report.] / Angiomiolipoma renal en un paciente con esclerosis tuberosa. Presentación de un caso clínico.

OBJECTIVE: To assess the importance of management and close follow-up of patients with tuberous sclerosis that associate renal angiomyolipomas. METHODS: To report a case. RESULTS: A 55 years old men with tuberous sclerosis diagnosed in childhood and later finding of bilateral giant renal masses in imaging studies, with significant compromise of renal function. The patient did not have a proper follow up and did not receive any treatment. At the moment he has end stage kidney disease. CONCLUSION: Patients that associate renal angiomyolipoma and tuberous sclerosis, have specific characteristics with a higher risk of complications requiring strict follow-up and specific treatment.

Giant retroperitoneal sarcoma: case report.

OBJECTIVE: To report a new case of giant retroperitoneal mass with silent beginning. METHODS: We present the case of a 36 year old man with a giant retroperitoneal liposarcoma 35 × 15 cm in size. The only symptom was a one month history of minimal abdominal pain. CONCLUSION: Liposarcoma is the most frequent retroperitoneal mass. In most of the cases clinical symptoms are silent, being this the reason why diagnosis is late and the size is large. The best image options are CT scan or MRI but final diagnosis is based on pathology results. Its treatment is surgery and relapse is very usual.