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Introduction: Minimally invasive surgery has been established as the gold standard for the treatment of localised renal tumours. A retroperitoneal approach is a feasible option with advantages in posterior tumours and patients with previous abdominal surgeries. In this context, single-port retroperitoneoscopic partial nephrectomy (SPOR-PN) has not been widely explored and developed. We present this technique's description and our first results. Methods: We present a case series of nine patients undergoing SPOR-PN in a single institution. We used a multi-channel single-port access dispositive through a 35 mm incision below the 12th rib, a 30° two-dimensional laparoscope, curved graspers and needle drivers on the left hand and standard rigid material in the right hand. In all surgeries, we performed a complete renorrhaphy with the sliding-clip technique. The pain was evaluated through visual analogue scale (VAS) the day after surgery. Results: Patients' age ranged from 44 to 78 years. The median RENAL score was 5p, and the mean surgical time was 134 min. We performed an 'off-clamp' procedure on three patients. Among the patients who had renal artery clamped, the median ischaemia time was 18 min. The median in-hospital stay time was 48 h. Median VAS the day after surgery was 2. None of the anatomical pieces had positive borders. Only one complication was reported (Clavien IIIa). Conclusions: SPOR-PN is a feasible minimally invasive and nephron-sparing technique. The advantages of this procedure may not be only a better cosmetic appearance but also less post-operative pain. Further development and larger studies are needed.
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INTRODUCTION: Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. AIMS: To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. METHODOLOGY: A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP-men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU-men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. VARIABLES: age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student's t-test, Chi2, multivariate analysis. RESULTS: There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). CONCLUSIONS: Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.
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Introduction: Injectable extended-release formulations of luteinizing hormone-releasing hormone agonists (LHRHa) have simplified the treatment of prostate cancer with a satisfactory level of androgen castration. This study aims to determine the percentage of patients whose initial LHRHa prescription was renewed during follow-up, how many changed formulation and how their quality of life evolved. Methods: This is an observational, prospective, multicentre study of men with prostate cancer who were to receive treatment with LHRHa (triptorelin every 3 or 6 months, leuprorelin every 3 or 6 months, or goserelin every 3 months) for 24 months. The treatment used was recorded and quality of life was assessed (QLQ-PR25 questionnaire) at four follow-up visits. Results: A total of 497 men (median age 75 years) were evaluated. The median exposure to LHRHa was 24 months. The initial prescription was renewed in 95.7% at follow-up 1 and 75% at follow-up 4. The main reason for changing from a 6-month to a 3-month formulation was a preference for sequential treatment (according to the investigator) and to see the physician more frequently (according to the patient). The main reason for switching from the 3-month to 6-month formulation was simplification of treatment (according to the investigator) and for convenience (according to the patient). Findings in the QLQ-PR25 questionnaire revealed no changes in urinary or bowel symptoms, though an improvement in sexual activity was reported. Practically all investigators and patients were satisfied/very satisfied with the treatment. Conclusion: Changes in formulation were scarce and generally justified by convenience factors or personal preferences. Patients maintained a good health status, with a high rate of retention of LHRHa treatment. Clinical Trial Registration: Study number: A-ES-52014-224.A plain language summary is provided as supplementary material (available at: https://www.drugsincontext.com/wp-content/uploads/2024/05/dic.2024-2-2-Suppl.pdf).
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Epidemiological studies have demonstrated that prevalence of hypogonadism in old males increases with every additional decade of life. These males present various symptoms including decrease of sexual function, decrease of cognitive function, altered lipid profile, increased visceral adiposity, changes in bone density and muscular strength secondary to atrophy. Currently, testosterone injections and gel preparations are the most used. Testosterone replacement therapy provides significant symptomatic improvements for men with late start hypogonadism. Long-term benefits and risks of testosterone replacement therapy will be more evident when testosterone effects are studied on all health related parameters over a prolonged period of time. There is a large ongoing multicentric randomized clinical trial sponsored by NIH for testosterone control in old men with low testosterone levels. Its results may give answers to the possible benefits and risks of testosterone replacement in aging males. If an aging male is diagnosed as late-start hypogonadism, the urologist should discuss with the patient potential benefits and risks of testosterone therapy. Aging males with significant erythrocytosis, untreated sleep apnea, prostate cancer and high risk of cardiovascular events must be excluded from testosterone replacement therapy. Currently, there are not enough evidences to clearly state that the benefits of testosterone replacement therapy in aging males are better than the risks of this treatment. A general recommendation cannot be given that testosterone replacement therapy may be applied to all aging males with low testosterone levels independently of significant signs or symptoms.
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Anciano/fisiología , Testosterona/deficiencia , Factores de Edad , Terapia de Reemplazo de Hormonas , Humanos , Hipogonadismo/tratamiento farmacológico , Hipogonadismo/epidemiología , Hipogonadismo/etiología , Masculino , Testosterona/uso terapéuticoRESUMEN
BACKGROUND: Living donor kidney transplantation (LDKT) is one of the best options for patients with chronic renal failure, but approximately one-third of cases are limited by incompatibility ABO and/or HLA between recipient and donor. This study aims to analyze the surgical complications and bleeding events presented in ABO-incompatible (ABOi) and HLA-incompatible (HLAi) patients within a pre-transplant desensitization program compared with ABO-compatible (ABOc) recipients. MATERIAL AND METHODS: We performed a retrospective analysis of ABOi and HLAi recipients undergoing LKDT between 2009 and 2019, resulting in a total of 62 patients that we compared with the same number of ABOc performed consecutively before 2019. The following variables were analyzed: surgical complications, presence, size and rate of reintervention of peri-graft hematomas, and number of transfusions received in the postoperative period. RESULTS: No statistical differences were shown in donor and recipient age, BMI, or sex; in the case of pre-surgical hematocrit, the ABOi group presented slightly lower figures. In the incompatible group (ABOi + HLAi), we found a greater number of postoperative surgical complications when analyzing the number of hematomas, size, need for surgical reintervention, and the number of blood units transfused; incompatible patients showed higher rates of hematomas, need for surgical reinterventions, and transfused units (P < .05). CONCLUSION: Desensitized patients need more transfusions, have a greater number and size of hematomas, and have higher reintervention rates. Although these are present in greater numbers, we did not observe statistically significant differences in the number of surgical complications.
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Trasplante de Riñón , Humanos , Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos , Rechazo de Injerto , Supervivencia de Injerto , Riñón , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Donadores Vivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Masculino , FemeninoRESUMEN
Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.
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OBJECTIVE: Kidney transplantation process involves a series of challenges such as the shortage of organs worldwide for a population waiting for a first and subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizing the ischemia time as much as possible, minimizing the impact of surgery and subsequent immunosuppressive therapy. METHODS: We carry out a review of the different advances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enabling the expansion of living donor programs as well as orga preservation strategies previous to transplantation surgery.The arrival of robotic surgery in the field of kidney transplantation has been an important milestone in the last decade, showing improvements compared to traditional open surgery, maintaining satisfactory functional results, although its implementation is currently reduced with technical limitations in the extension to any type of recipient. New immunosuppressive agents that minimize potential side effects or reduce anticalcineurinic drugsdoses are also important lines of research. CONCLUSIONS: The future of kidney transplantation involves the search for increasingly global strategies to improve the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the different areas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools in the field of tissue generation or targeted immunosuppressive therapies.
OBJETIVO: El proceso del trasplante renal conlleva una serie de retos como son la escasez de órganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injertomás apropiado para cada receptor optimizando al máximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora.MÉTODOS: Realizamos una revisión de los diferentes avances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes,posibilitar la expansión de programas de donante vivo así como las estrategias de preservación del órgano previamente a la cirugía del implante.El desembarco de la cirugía robótica en el campo del trasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en la actualidad con limitaciones técnicas en la extensión a cualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicos son también líneas importantes de investigación. CONCLUSIONES: El futuro del trasplante renal pasa por la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en el acondicionamiento y preservación de los injertos o el desarrollo a escala global de la cirugía mínimamente invasiva en los diferentes ámbitos del trasplante renal. El peso de las biotecnologías y terapias génicas suponen herramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.
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Trasplante de Riñón , Humanos , Donadores VivosRESUMEN
OBJECTIVES: To present a revision on the signet-ring cell bladder adenocarcinomas found in our department. METHODS/RESULTS: We reviewed all the transurethral resections of the bladder (TURB) performed between 1990 and 2009 finding 9 cases of primary signet ring cell adenocarcinomas (4 pure and 5 mixed). Eight were male and one female, with ages between 39 and 82 years. Definitive treatment was radical cystectomy with Bricker's urinary diversion in four patients, cysctectomy with Mainz's II diversion in one patient and palliative management with TURB in three cases and percutaneous nephrostomy in the remaining case. We used adyuvant chemotherapy in three cases. Only two patients were alive at the time of the study. Mean survival was 327 days for pure tumors and 586 for the mixed ones. CONCLUSIONS: Signet-ring cell primary adenocarcinoma of the bladder is an uncommon type of tumor, with worse prognosis than transitional cell cancer. It is important to discard other possible metastatic origins(like stomach, prostate, lung, or ovary) because the management will be different. Radical cystectomy is the treatment of choice, with adyuvant chemotherapy if possible. Five year survival is less than 11%
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Carcinoma de Células en Anillo de Sello , Neoplasias de la Vejiga Urinaria , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células en Anillo de Sello/diagnóstico , Carcinoma de Células en Anillo de Sello/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
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.
INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad.MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España.RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia.
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Infecciones por Coronavirus , Pandemias , Neoplasias del Pene , Neumonía Viral , Andrología , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Masculino , Neoplasias del Pene/diagnóstico , Neoplasias del Pene/terapia , Neumonía Viral/epidemiología , SARS-CoV-2 , EspañaRESUMEN
OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.
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Trasplante de Riñón/efectos adversos , Pierna , Linfocele/etiología , Anciano , Femenino , Humanos , Linfocele/diagnóstico , Linfocele/cirugíaRESUMEN
SUMMARY OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia surgery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy.
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Hernia Inguinal , Enfermedades Ureterales , Anciano de 80 o más Años , Hernia Inguinal/diagnóstico por imagen , Humanos , Masculino , Radiografía , Enfermedades Ureterales/diagnóstico por imagenRESUMEN
From the first radical prostatectomy (RP), this kind of surgeries have always led to the need of a vesicourethral anastomosis (VUA). We present a case of a 65 year-old patient with diagnosis of prostate cancer and candidate for laparoscopic RP. The approach was a conventional extraperitoneal access with complete urethral sparing that avoids the need of VUA. Bladder catheter was removed on the third postoperative day observing immediate urinary continence. The anatomopathological analysis revealed a pT2 adenocarcinoma with negative margins. We report for the first time, a minimally invasive technique that avoids the need of VUA with favorable functional results.
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OBJECTIVES: Estimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. MATERIAL AND METHODS: Type of study: Observational study of prevalence in men with essential hypertension. MEASUREMENTS: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). RESULTS: The study included 262 hypertensive men with an average age of 65.84years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. CONCLUSIONS: Erectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome.
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Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Hipertensión/complicaciones , Calidad de Vida , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de RiesgoRESUMEN
Bacilus Calmette-Guerin (BCG) administered intravesical is an effective therapy in non muscle invasive bladder cancer (NMIBC), but it presents limitations regarding recurrence and toxicity. For years, many case series have been published where sequential therapy with BCG and Mitomycin C (MMC) was tried. In this article, we perform a review of the data supplied by these articles with the aim to determine the safety and efficacy of combination, and what is the group of patients it should be indicated. Many studies show that combination therapy did not cause more toxicity and improved the interval free of disease with decrease of tumor progression compared to BCG or MMC monotherapy. Therefore, a combination of MMC and BCG therapy seems safe, but more clinical studies are required for a future evaluation.
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Adyuvantes Inmunológicos/administración & dosificación , Antibióticos Antineoplásicos/administración & dosificación , Vacuna BCG/administración & dosificación , Mitomicina/administración & dosificación , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Quimioterapia Combinada , Humanos , Invasividad Neoplásica , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
The androgen-signaling axis plays a pivotal role in the pathogenesis of prostate cancer. Since the landmark discovery by Huggins and Hodges, gonadal depletion of androgens has remained a mainstay of therapy for advanced disease. However, invariably progression to castration-resistant prostate cancer (CRPC) occurs within 2-3 years of initiation of ADT. Multiple mechanisms of resistance help contribute to the progression to castration resistant disease, and the androgen receptor (AR) remains an important driver in this progression. Molecular mechanisms behind AR reactivation in CRPC include AR gene amplification and overexpression, AR mutations, expression of constitutively active AR variants, intratumoral and adrenal androgen synthesis and promiscuous AR activation by other factors. Other AR-independent resistance mechanisms, including activation of glucocorticoid receptor, impairment of DNA repair pathways, immune-mediated resistance, neuroendocrine differentiation and microRNA expression, are also discussed. Castration-resistant prostate cancer is a complicated disease, characterized by multiple resistance mechanisms to androgen deprivation treatment, and it remains an incurable disease. An understanding of the mechanisms underlying this resistance is necessary to identify future therapeutic targets as well as the identification and validation of novel predictive biomarkers of resistance; they may lead to improved therapeutics for mCRPC patients.
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Neoplasias de la Próstata Resistentes a la Castración , Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Neoplasias de la Próstata Resistentes a la Castración/etiología , Receptores Androgénicos/genética , Receptores Androgénicos/fisiologíaRESUMEN
In this article several members of diverse scientific associations and reproduction experts from Spain have updated different genetic and immunological procedure recommendations in couples affected by reproductive dysfunction with the goal of providing a set of useful guidelines for the clinic. The laboratory test has been considered as highly recommendable for making clinical decisions when the result of the diagnostic test is relevant, moderately recommendable when the results are of limited evidence because they are inconsistent, and low when the benefit of the test is uncertain. It is expected that these recommendations will provide some useful guidelines for the diagnosis, prognosis and treatment of couples presenting reproductive dysfunction.
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Infertilidad Femenina/genética , Infertilidad Femenina/inmunología , Infertilidad Masculina/genética , Infertilidad Masculina/inmunología , Aberraciones Cromosómicas , Concepción de Donantes/normas , Epigénesis Genética , Femenino , Enfermedades Genéticas Congénitas/diagnóstico , Pruebas Genéticas/clasificación , Pruebas Genéticas/normas , Humanos , Masculino , Reproducción/ética , Factores SexualesRESUMEN
Varios miembros de diferentes asociaciones científicas y expertos de la reproducción han actualizado las recomendaciones de estudio genético e inmunológico en las parejas con disfunción en la reproducción con el fin de mejorar la asistencia sanitaria. El estudio se ha considerado altamente recomendable cuando la prueba diagnóstica es relevante para la toma de decisiones, moderada cuando estas han mostrado un resultado poco consistente y baja, cuando el beneficio de la prueba es incierto. Con la indicación de estas recomendaciones obtendremos una información relevante para el diagnóstico, pronóstico y tratamiento de la pareja con disfunción en la reproducción
In this article several members of diverse scientific associations and reproduction experts from Spain have updated different genetic and immunological procedure recommendations in couples affected by reproductive dysfunction with the goal of providing a set of useful guidelines for the clinic. The laboratory test has been considered as highly recommendable for making clinical decisions when the result of the diagnostic test is relevant, moderately recommendable when the results are of limited evidence because they are inconsistent, and low when the benefit of the test is uncertain. It is expected that these recommendations will provide some useful guidelines for the diagnosis, prognosis and treatment of couples presenting reproductive dysfunction
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Humanos , Infertilidad/diagnóstico , Pruebas Inmunológicas/métodos , Pruebas Genéticas/métodos , Técnicas Reproductivas/ética , Aborto Habitual/genética , Análisis Citogenético/métodos , Fenómenos Fisiológicos Reproductivos/genética , Fenómenos Fisiológicos Reproductivos/inmunología , Pautas de la Práctica en Medicina , Asesoramiento Genético/organización & administración , Infertilidad Masculina/genética , Enfermedades Genéticas Congénitas/prevención & controlRESUMEN
Objetivo: El proceso del trasplante renalconlleva una serie de retos como son la escasez deórganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injerto más apropiado para cada receptor optimizando almáximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora. Métodos: Realizamos una revisión de los diferentesavances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes, posibilitar la expansión de programas de donante vivo así como las estrategias de preservación delórgano previamente a la cirugía del implante. El desembarco de la cirugía robótica en el campo deltrasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en laactualidad con limitaciones técnicas en la extensión acualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicosson también líneas importantes de investigación.Conclusiones: El futuro del trasplante renal pasapor la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en elacondicionamiento y preservación de los injertos o eldesarrollo a escala global de la cirugía mínimamenteinvasiva en los diferentes ámbitos del trasplante renal. Elpeso de las biotecnologías y terapias génicas suponenherramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.(AU)
Objetive: Kidney transplantation process involves a series of challenges such as the shortageof organs worldwide for a population waiting for a firstand subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizingthe ischemia time as much as possible, minimizing theimpact of surgery and subsequent immunosuppressivetherapy.Methods: We carry out a review of the differentadvances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enablingthe expansion of living donor programs as well as organpreservation strategies previous to transplantation surgery. The arrival of robotic surgery in the field of kidneytransplantation has been an important milestone in thelast decade, showing improvements compared to traditional open surgery, maintaining satisfactory functionalresults, although its implementation is currently reducedwith technical limitations in the extension to any type ofrecipient. New immunosuppressive agents that minimizepotential side effects or reduce anticalcineurinic drugsdoses are also important lines of research.Conclusions: The future of kidney transplantationinvolves the search for increasingly global strategies toimprove the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the differentareas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools inthe field of tissue generation or targeted immunosuppressive therapies.(AU)
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Humanos , Trasplante de Riñón , Obtención de Tejidos y Órganos , Donantes de Tejidos , Procedimientos Quirúrgicos RobotizadosRESUMEN
INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad. MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España. RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia
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
Asunto(s)
Humanos , Masculino , Infecciones por Coronavirus/prevención & control , Neumonía Viral/prevención & control , Pandemias , Andrología/normas , Neoplasias del Pene/diagnóstico , Neoplasias del Pene/terapia , Telemedicina , Guías de Práctica Clínica como Asunto , Medicina Basada en la EvidenciaRESUMEN
Objetivos: Estimar la frecuencia de disfunción eréctil en pacientes con hipertensión arterial y las variables asociadas, el grado de control, el riesgo cardiovascular y el impacto en la calidad de vida. Material y métodos: Tipo de estudio: estudio observacional de prevalencia en varones con hipertensión arterial. Mediciones: de cada paciente se recogieron variables sociodemográficas y de comorbilidad (edad, índice de Charlson, dislipemia e hipertrofia benigna de próstata), grado de control de la hipertensión arterial y tratamiento, riesgo cardiovascular y síndrome metabólico. La disfunción eréctil se diagnosticó mediante el índice internacional de función eréctil (IIEF-15). Se realizaron los cuestionarios de calidad de vida en hipertensión arterial (MINICHAL) y la escala internacional de síntomas prostáticos (IPSS). Resultados: El estudio incluyó 262 hombres hipertensos con una media de 65,84años de edad. El 46,1% presentó disfunción eréctil, siendo en el 54,9% de grado severo. El análisis bivariado muestra una asociación independiente entre la disfunción eréctil y las variables: edad, índice de Charlson, dislipemia, hipertrofia benigna de próstata, presión arterial diastólica, años de diagnóstico de la hipertensión, número de tratamientos, score de Regicor y Framingham-Wilson, glucemia, creatinina y GPT, filtrado glomerular mediante la fórmula MDRD, sintomatología irritativa (IPSS) y manifestaciones somáticas (MINICHAL). El modelo multivariado final encontró asociación con la edad, presentar dislipemia, hipertrofia benigna de próstata y síndrome metabólico. Conclusiones: La disfunción eréctil se asocia significativamente con la edad, presentar dislipemia, hipertrofia benigna de próstata y síndrome metabólico
Objectives: Estimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. Material and methods: Type of study: Observational study of prevalence in men with essential hypertension. Measurements: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). Results: The study included 262 hypertensive men with an average age of 65.84years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. Conclusions: Erectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome