RESUMEN
BACKGROUND: Total Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA. METHODS: Prospective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group. DISCUSSION: The aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery. TRIAL REGISTRATION: Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).
Asunto(s)
Adenocarcinoma/cirugía , Laparoscopía , Arteria Mesentérica Inferior , Venas Mesentéricas , Complicaciones Posoperatorias/prevención & control , Neoplasias del Recto/cirugía , Disfunciones Sexuales Fisiológicas/prevención & control , Adulto , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Humanos , Masculino , Estudios ProspectivosRESUMEN
OBJECTIVES: To validate in Spanish (Spain) a self-administered questionnaire on the quality of life (QoL) specific to nocturia in an older adult male population. MATERIAL AND METHODS: We analysed the Spanish version of the ICIQ-Nqol questionnaire (provided by ICIQ who owns the copyright), which meets the translation criteria required by the validation protocol. The study included 69 male patients older than 60 years of age with 1 or more nocturia episodes. The participants completed the questionnaire on two occasions, along with other Spanish-validated questionnaires that measure the QoL related to urinary symptoms. We analysed the internal reliability and consistency, reproducibility, convergent validity and discriminant validity. RESULTS: The study included 69 men, with a mean age of 70.64 years (range, 60-87 years). Both the overall scale and the energy/sleep subscale met the minimum criteria for internal reliability and consistency. A good correlation has been demonstrated between the overall index of the ICIQ-Nqol questionnaire and the other questionnaires included in the study. The reproducibility (test-retest reliability) of both the overall scale and subscales of the ICIQ-Nqol and the other questionnaires was demonstrated. Conclusions The ICIQ-Nqol questionnaire has been shown to be an appropriate instrument for assessing the symptomatic intensity and impact on the QoL of patients with nocturia. This study confirms its validity for a Spanish-speaking male population. Neurourol. Urodynam. 35:847-850, 2016. © 2015 Wiley Periodicals, Inc.
Asunto(s)
Nocturia/diagnóstico , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , España , Evaluación de Síntomas , TraduccionesRESUMEN
Patients undergoing radical prostatectomy for prostate cancer may experience erectile dysfunction (ED). Age of patients, experience of the surgeons and existence of ED before surgery are factors related to its appearance. The objective of the study was to assess the hemodynamic changes produced in the cavernous arteries in patients undergoing laparoscopic radical prostatectomy (LRP) measured with penile Doppler ultrasound (PDUS). A prospective database of 83 patients undergoing LRP was analysed. PDUS were performed at baseline and twelve months after surgery. International Index of Erectile Function (IIEF) and Erectile Hardness Score (EHS) questionnaires were also evaluated. A 12-month decrease in all hemodynamic parameters of both cavernous arteries was found except for the end diastolic velocity (EDV) on the left cavernous artery. Only changes between baseline and twelve-months mean values of the diameter (0.725 vs. 0.67 mm; p= 0.033) and peak systolic velocity (PSV) of the right cavernous artery (32.6 vs. 27.22 cm/s; p = 0.004) presented significant variations. The rest of the parameters were close to statistical significance, except for EDV of the right cavernous artery (p = 0.887). The erectile function domain of the IIEF showed a significant decrease (median at baseline: 26 vs. post-surgery: 7; p < 0.0001) as well as the EHS test (grade I at baseline: 2.4% vs. 12-months: 31.3%; p < 0.0001). Our study supports the idea that LRP produces local vascular injuries. A decrease in the PSV and in the diameter of both cavernous arteries was observed with PDUS and it may explain the vascular origin of ED.
Asunto(s)
Disfunción Eréctil , Laparoscopía , Pene , Prostatectomía , Neoplasias de la Próstata , Ultrasonografía Doppler , Humanos , Masculino , Prostatectomía/métodos , Laparoscopía/métodos , Pene/irrigación sanguínea , Pene/diagnóstico por imagen , Persona de Mediana Edad , Ultrasonografía Doppler/métodos , Anciano , Disfunción Eréctil/etiología , Estudios Prospectivos , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/diagnóstico por imagen , Hemodinámica/fisiología , Arterias/diagnóstico por imagenRESUMEN
We present herein a 72-year-old male with a long history of mild lower urinary tract symptoms, with a serum prostate-specific antigen level value of 87.9 ng/mL and an estimated prostate size of 3987 mL, according to magnetic resonance imaging. Prostatic biopsies showed benign prostatic hyperplasia. Prostatic surgery has not been required. To the best of our knowledge, this is the highest prostate volume reported in the medical literature.
Asunto(s)
Próstata/patología , Hiperplasia Prostática/patología , Anciano , Humanos , Masculino , Tamaño de los ÓrganosRESUMEN
Heterophilic antibodies are human immunoglobulins directed against various animal antigens. They can produce false-positive results in the analysis of different tumor markers, including prostate-specific antigen. This interference can lead to misdiagnosis, unnecessary tests, and overtreatment in some cases. We present herein the case of a 52-year-old man with repeated spurious elevation of prostate-specific antigen, reaching levels of 108.7 ng/mL, that were suspected to be caused by heterophilic antibodies. The interference was solved by changing the analysis technique. Real values of prostate-specific antigen were less than 1 ng/mL.
Asunto(s)
Anticuerpos Heterófilos/inmunología , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Reacciones Falso Positivas , Humanos , Luminiscencia , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/inmunologíaRESUMEN
Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 µg vitamin B9, 1 µg vitamin B12, 10 mg zinc, 50 µg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment.
Asunto(s)
Antioxidantes/administración & dosificación , Daño del ADN/efectos de los fármacos , ADN/análisis , Infertilidad Masculina/etiología , Espermatozoides/química , Varicocele/complicaciones , Ácido Ascórbico/administración & dosificación , Carnitina/administración & dosificación , Supervivencia Celular , Fragmentación del ADN , Suplementos Dietéticos , Femenino , Humanos , Infertilidad Masculina/tratamiento farmacológico , Masculino , Embarazo , Recuento de Espermatozoides , Motilidad Espermática , Espermatozoides/anomalías , Espermatozoides/fisiología , Ubiquinona/administración & dosificación , Ubiquinona/análogos & derivados , Varicocele/tratamiento farmacológico , Complejo Vitamínico B/administración & dosificación , Vitamina E/administración & dosificación , Zinc/administración & dosificaciónRESUMEN
Altered p53 status is a frequent event in bladder cancer and reported to have prognostic significance. We studied the TP53 gene and its product in 76 patients affected with urinary bladder carcinomas by immunohistochemistry (mAb DO-7), polymerase chain reaction single-strand conformational polymorphism (exons 4-8) followed by direct sequencing of shifted bands, and loss of heterozygosity in 17p (p53CA). H-RAS mutations were also studied. The receiver operating characteristic curve and the logistic-regression analysis were used to evaluate the validity of immunohistochemistry in predicting TP53 mutations. A p53-positive nuclear phenotype was defined by a cutoff of 20% tumor cells being immunoreactive and was found in 23 cases, while TP53 mutations were detected in 22 cases, four of them with a negative p53 phenotype. TP53 deletions were identified in 23 cases. No H-RAS gene mutations were observed. There was a significant association between phenotype and genotype results. Moreover, a significant association was observed between p53 status and tumor stage and grade, being alterations more common in high-stage and high-grade tumors (both chi2 test; P < .01). Deletion of 17p significantly correlated with tumor stage (P < .01) and grade (P = .01), allelic losses being more common in advanced disease. Data from these studies suggest that genetic assays are necessary for the optimal determination of TP53 alterations, mainly in tumors with a p53 negative phenotype, and especially in early stage tumors for which p53 status may assist in determining its progression to invasive disease. Since p53 alterations are significantly associated to clinicopathological features of poor prognosis, the inclusion of both p53 phenotype and TP53 mutation status into a predictive panel of tumor markers for bladder cancer is recommended.
Asunto(s)
Carcinoma de Células Transicionales/genética , Pérdida de Heterocigocidad , Proteína p53 Supresora de Tumor/genética , Neoplasias de la Vejiga Urinaria/genética , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Carcinoma de Células Transicionales/metabolismo , Carcinoma de Células Transicionales/patología , Cromosomas Humanos Par 17 , Análisis Mutacional de ADN , ADN de Neoplasias/análisis , Progresión de la Enfermedad , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo Conformacional Retorcido-Simple , Estudios Prospectivos , Proteína p53 Supresora de Tumor/metabolismo , Neoplasias de la Vejiga Urinaria/metabolismo , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication.
Asunto(s)
Adenocarcinoma/cirugía , Laparoscopía/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , PeritoneoRESUMEN
Introducción: El quiste epidermoide testicular es una lesión de comportamiento benigno que representa menos del 1% de todos los tumores testiculares. Caso clínico: Presentamos el caso de un varón de 52 años que consultó por enfermedad de Peyronie. En la exploración, se observó una tumoración testicular izquierda. Al sospechar malignidad, se realizó orquiectomía radical. La anatomía patológica reveló el diagnóstico de quiste epidermoide. Revisamos la literatura y aportamos un nuevo caso. Discusión: Dada la baja frecuencia de esta lesión, a pesar de presentar datos típicos, su diagnóstico diferencial con lesiones malignas testiculares puede resultar difícil. Conclusión: Reivindicamos la importancia de la exploración física ante cualquier paciente que acude a la consulta de andrología. La sospecha de quiste epidermoide en el diagnóstico preoperatorio puede ayudar a estos pacientes a beneficiarse de un tratamiento conservador (AU)
Introduction: Testicular epidermoid cyst is a benign lesion that represents less than 1% of all testicular tumors. Clinical Case: We present the case of a 52-year-old man with Peyronie's disease. The physical examination showed a left testicular tumor. Due to suspected malignancy, radical orchiectomy was performed. The histopathology study revealed an epidermoid cyst. We have reviewed the literature and provide a new case report. Discussion: Due to the low frequency of this lesion, despite having typical signs, its differential diagnosis with testicular malignancy may be difficult. Conclusion: We assert the importance of the physical examination of any patient who comes for andrology consultation. Suspicion of epidermoid cyst in the preoperative diagnosis can help these patients benefit from conservative treatment (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Quiste Epidérmico/complicaciones , Quiste Epidérmico/diagnóstico , Enfermedades Testiculares/complicaciones , Enfermedades Testiculares/diagnóstico , Enfermedades Testiculares/cirugía , Quiste Epidérmico/fisiopatología , Quiste Epidérmico/cirugía , Quiste Epidérmico , Enfermedades Testiculares/fisiopatología , Enfermedades TesticularesRESUMEN
OBJETIVOS: Presentar nuestra experienciainicial en la práctica de la prostatectomía radicallaparoscópica por via extraperitoneal. Se describe latécnica quirúrgica y se revisan las dificultades técnicas,los costes de tiempo y las complicaciones.MÉTODOS: Entre Enero y Mayo de 2005 hemos indicado17 prostatectomías radicales laparoscópicas porvia extraperitoneal en nuestro centro. Dos de ellas serealizaron con ayuda de un maestro. La técnica empleada,de la que se hace una somera descripción, es lade Bruselas.RESULTADOS: De las 17 cirugías, se ha completado elprocedimiento íntegramente por laparoscopia en ochocasos. De los casos realizados sin ayuda externa y queson los que se analizan en este trabajo, 6 han sido íntegramentelaparoscópicos y 9 han requerido reconversión a cirugía abierta. De los últimos 6 únicamente sereconvirtió 1. El tiempo quirúrgico medio ha sido 304minutos (355 para las completadas por laparoscopia).La tasa de transfusión es del 13% . Los márgenes positivoshan sido del 26% (16% en los laparoscópicospuros). No ha habido complicaciones mayores ni íleosparalíticos prolongados. En un caso se tuvo que recolocarla sonda a los 7 días de la intervención. La reconversiónde la vía extraperitoneal a cirugía abierta no escompleja al no estar abierta la cavidad peritoneal perorequiere de experiencia previa en cirugía abierta puestoque los planos no se observan con facilidad.CONCLUSIONES: La prostatectomía radical laparoscópicaextraperitoneal es factible en un centro de nuestrascaracterísticas siempre y cuando se disponga deun equipo con experiencia previa en laparoscopia yse este dispuesto a invertir un considerable esfuerzoespecialmente en lo que respecta al número de horasde quirófano. El aprendizaje no se ha traducido encomplicaciones importantes
OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication