Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery.

INTRODUCTION: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery. METHODS: Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. RESULTS: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067). CONCLUSIONS: AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Female Urethroplasty: Anterior Vaginal Wall Flap (Blandy Flap) - Simpler Tends to Be Better.

Urethral stricture is a rare condition in women, representing a diagnostic challenge for the urologist. Its main etiology is traumatic or due to labor. Definitive treatment can be by means of dilations or urethroplasty using both local flaps and free grafts. In this study, we report the case of a patient with voiding symptoms during a period of 9 years after childbirth, despite an attempt of urethral dilation and chronic self-catheterization. The patient was finally diagnosed of a long distal urethral stricture, and she underwent urethroplasty with an anterior vaginal wall flap with satisfactory results. We take the opportunity to briefly review the diagnostic pathway in women with obstructive symptoms and the main female urethroplasty techniques.

[Pulmonary tumorlet associated with second neoplasia]. / Asociación de tumorlet pulmonar con segundas neoplasias.

Tumorlets are pulmonary neuroendocrine tumors smaller than 0.5 cm. They are benign and usually asymptomatic. Their diagnosis is important so as to differentiate them from other neuroendocrine pathologies that require therapeutic intervention. We report a case of such entity and a discussion on the subject that can contribute to highlight the importance of diagnosing this entity.

Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair-case report.

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O'Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.

[Mediastinal sarcoidal reaction in follow up for seminoma]. / Reaccion sarcoidal mediastinal en el seguimiento de un paciente con seminoma.

Mediastinal sarcoidal reaction in follow up for seminoma. Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a semi-nomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis.

Asociación de tumorlet pulmonar con segundas neoplasias / Pulmonary tumorlet associated with second neoplasia

Los tumorlets son tumores neuroendocrinos pulmonares menores a 0.5 cm, de evolución benigna y habitualmente asintomáticos. Su diagnóstico es importante para realizar la diferenciación con otras afecciones neuroendocrinas y enfermedad metastásica de otro origen, que requerirán una intervención terapéutica. Se presenta un caso de dicha entidad asociada a otros tumores.

Tumorlets are pulmonary neuroendocrine tumors smaller than 0.5 cm. They are benign and usually asymptomatic. Their diagnosis is important so as to differentiate them from other neuroendocrine pathologies that require therapeutic intervention. We report a case of such entity and a discussion on the subject that can contribute to highlight the importance of diagnosing this entity.

Remuneraciones profesionales médicas / Medical remunerations

Desde que Aristóteles en su Ética a Nicomaco expresaba que "el fin que persigue el arte de la medicina es la salud" la profesión y la condigna remuneración de los médicos fueron consideradas en alta estima por parte de todos cuantos requerían de los servicios asistenciales médicos. Era sin lugar a dudas la del médico una de las profesiones más elogiosamente reconocidas y mejor remuneradas dentro de las variadas disciplinas humanas. En el presente trabajo se procura recrear la variable historia de las remuneraciones médicas y el particular destrato que ellas merecen en la actualidad en la República Argentina. Se hacen las consideraciones éticas, morales, laborales y legales sobre los conceptos remunerativos del médico y su discriminación cuando son considerados "honorarios" y cuando son considerados simplemente "salarios". Se concluye necesariamente que la histórica y merecida buena imagen del médico como agente de la salud se ha deteriorado y devaluado paulatinamente hasta llegar al presente en muchas comunidades a revestir el carácter de irrisoria, particularmente en lo atinente a su remuneración. Se toma en cuenta que en la actualidad la actividad médica depende no ya de sus pacientes asistidos, sino de terceros que ofician como pagadores de las prestaciones, preocupándose las más de las veces por el superávit económico que por el superávit de la salud. La labor médica se ha convertido en un mero objeto de intercambio y contienda económica, abandonando el espíritu de solidaridad individual y social de la atención para la salud. La medicina pasó a tomar parte integral de un "complejo comercial – industrial" para la salud y todo ello sin considerar la formación humana y profesional del médico, su permanente incentivo en estudiar y agregar conocimientos a su arte y sin verificarlo como una entidad esencial como soporte natural en la salud de la comunidad...

Since Aristoteles wrote in his "Etica a Nicomaco" was expressing that "the end that chases the art of the medicine is the health…", the profession and the deserved doctor’s remuneration were high esteem and consideration on the part for all those were needing of the welfare medical services. It was no doubt that the doctor, one of the professions more eulogistically recognized and best remunerated inside the varied human disciplines. In the present work one gets to recreate the changeable history of the medical remunerations and the individual mistreatment that they deserve at present in the Argentine Republic. There’re done the ethical, moral, labour and legal considerations on the remunerative of the doctor and his discrimination among when it’s considered to be "honorarium" and when are considered simply "wages". It concludes necessarily in that the historical and welldeserved good image of the doctor as a health’s agent, has deteriorated and gradually devaluated, up to managing to the present in many communities to re-dress the character of derisory, particularly in the relating thing to his remuneration. It born in mind that at present the medical activity depends not already on his assisted patients, but of third that officiate as payers presentations, worrying more of the times for the economic surplus that for the health’s surplus. The medical labor has turned into a mere exchange’s object and economic contest, leaving the spirit of individual and social solidarity for the health’s attention. The medicine passed to take integral report of a "commercial complex-industrially"for the health and all this without considering the doctor’s human and professional training, his art and withoutchecking it as an essential entity as natural support in the community’s health...

Reacción sarcoidal mediastinal en el seguimiento de un paciente con seminoma / Mediastinal sarcoidal reaction in follow up for seminoma

El cáncer de células germinales de testículo es el modelo de neoplasia curable. Las complicaciones a largo plazo son bien conocidas y el seguimiento incluye la pesquisa no sólo de la recaída, sino también de la aparición de segundos tumores y secuelas del tratamiento empleado. Un aumento de la incidencia de lesiones con granulomas tipo sarcoidosis se ha descripto en las últimas dos décadas en pacientes curados quienes en el seguimiento se presentan con nódulos pulmonares o adenopatías mediastinales.Se presenta el caso clínico de un paciente de 28 años quien durante el seguimiento clínico por un tumor seminomatoso, muestra en la tomografía axial computada y radiografía de tórax la presencia de adenopatías en mediastino, sin evidencia de enfermedad en abdomen y pelvis, el otro testículo normal y marcadores negativos.Ante esta peculiar situación, se realiza mediastinoscopia diagnosticándose reacción sarcoidal en ganglio mediastinal. Durante el seguimiento de pacientes con tumores germinales de testículo la presencia de adenopatías mediastinales exige contar con el diagnóstico histológico y tener en cuenta a la sarcoidosis en el diagnóstico diferencial

Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a seminomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis

Cáncer de pulmón: relación entre el tamaño ganglionar e invasión neoplásica en pacientes resecados / Lung cancer: relation between lymph node size and tumoral involvement in operated patient

Entre el 1-I-1986 y el 31-XII-1990, se operaron 60 pacientes que cumplieron una serie de requisitos preestablecidos de inclusión al presente trabajo. Edad promedio de 58,8 años, 54 de ellos eran hombres. Se abordaron por toracotomía axilar vertical amplia realizando 47 lobectomías, 4 bilobectomías y 9 neumonectomías con vaciamiento mediastinal. Hubo 37 adenocarcinomas, 18 epidermoides y 5 carcinomas indiferenciados a grandes células. Se estudiaron en promedio 6 grupos ganglionares, y 1096 adenopatías (x 18,3). Tenían metástasis 124 ganglios (11,3%) distribuídos en 25 casos (41,6%). El porcentaje de N positivos según el tamaño del N fue: 0 a 5 mm, 11,4%; 6 a 10 mm, 15,6%; 11 a 15 mm, 8,2%; 16 a 20mm, 7,8%; 21 mm ó más, 1,2%. De los 79 N mayores de 21 mm, solo hubo un N positivo. El agrandamiento en los negativos se debió a la respuesta inmunológica. El 83%de los N positivos medía 10 mm ó menos (38,7%para los menores de 5 mm). El 48%de los casos con N positivos solo tenía compromiso de un ganglio, 7 de los cuales eran debidos a micrometástasis única. La sensibilidad de la citología fue del 97,4%y de la especificidad del 100%. De 37 casos de estadio clínico III por adenomegalias presuntamente metastáticas, quedaron 27 al descartarse histológicamente su compromiso neoplásico. Debería darse más importancia a la presencia de N positivos pequeños y a las micrometástasis. Por encontrar que un 38,7%(48/124) de los N positivos medían 5 mm ó menos, nos definimos, entre los métodos de estadificación quirúrgica, por el vaciamiento mediastinal lo más amplio posible

Lipomas broncopulmonares / Broncopulmonary lipomas

Se presentan 2 casos de lipomas broncopulmonares observados en un período de 14 años, en la revisación de un total de 381 enfermos portadores de tumores. Un caso correspondió a un lipoma endobronquial que requirió para su curación una pleuroneumonectomía por las complicaciones del parénquima postobstrucción; el otro se trataba de un lipoma periférico en el que se realizó sólo una resección atípica conservadora. Ambos evolucionaron favorablemente. Se concluye en la necesidad del diagnóstico temprano para evitar resecciones mayores. Se menciona el uso de la laseroterapia por vía endoscópica para el tratamiento de los tumores benignos endobronquiales