Vaginal erbium laser for treatment of stress urinary incontinence: optimization of treatment regimen for a sustained long-term effect.

Stress urinary incontinence (SUI) is a common health problem that affects roughly 35% of women in the reproductive period. A prospective uncontrolled study was conducted to assess the long-term efficacy and safety of a non-ablative Er:YAG laser treatment of SUI. Forty-three patients participated in the study. All women underwent three sessions of IncontiLase® procedure, and efficacy of laser treatment was assessed by 1-h pad test, 24-h pad test, 3-day voiding diary, and ICIQ-UI SF questionnaire at multiple follow-ups. Statistical analysis was performed using one-way repeated measures ANOVA. Patients were questioned about discomfort during treatment and any adverse events following the laser procedures. All outcome measures showed a significant change over a period of the entire clinical trial. Eighteen-month follow-up revealed a fading of the effect, which was alleviated by single-session maintenance treatments every 6 months. There were no serious adverse events reported during the study. All reported side effects were mild and transient. The application of non-ablative Er:YAG laser for SUI treatment significantly improves the SUI symptoms. High improvement rates and patient satisfaction can be maintained with single-session maintenance treatments performed every 6 months. Long-term safety profile of multiple non-ablative Er:YAG laser treatment is shown. NCT04348994, 16.04.2020, retrospectively registered.

Nonablative transurethral Erbium:YAG laser treatment for chronic prostatitis/chronic pelvic pain syndrome: A prospective comparative study.

AIMS: This prospective study aimed to compare the clinical outcomes between the use of Erbium:YAG (Er:YAG) laser in a nonablative mode, to the use of the pharmacological treatment of oral tadalafil for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: The laser group received two sessions of Erbium:YAG laser, administered intraurethrally in a long, nonablative train of long pulses (SMOOTH™ mode), applied at the level of the male prostatic urethra. Tadalafil group received oral tadalafil at a dose of 5 mg/day, consecutively for 2 months. Effectiveness was assessed using the International Prostate Symptom Score (IPSS) questionnaire, VAS (visual analogue scale) pain score, and maximum urethral flow at follow-up visits up to 12 months after initiating treatment. Adverse effects were recorded after each treatment and follow-up sessions. RESULTS: The results show a significant decrease in the IPSS score in both groups up to the 12-month follow-up. The increase in Q-max was evident up to 3-months follow-up in the tadalafil group and up to 6 months in the laser group. The decrease in the VAS pain score was also significant in both treatment groups, lasting up to 3 months in the tadalafil group and up to 6 months in the laser group. CONCLUSIONS: The nonablative Er:YAG SMOOTH™ laser seems to be a promising treatment for this widely occurring condition. More studies are needed to confirm its safety and efficacy.

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study.

OBJECTIVES: Genitourinary syndrome of menopause (GSM) combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction, which is a result of urethral atrophy. There are several treatment methods available for the management of vulvovaginal symptoms of GSM, whereas urinary tract dysfunction often remains overlooked and undertreated. The objective of this pilot study was to assess the safety and efficacy of intraurethral Er:YAG laser treatment of urinary symptoms of GSM. PATIENTS AND METHODS: Patients with diagnosed GSM, having less than 5% of vaginal superficial cells in the cytology, vaginal pH higher than 5, with urinary symptoms of GSM (dysuria, frequency, urgency) and impaired continence due to urethral atrophy, received two sessions of intraurethral Er:YAG laser with a 3-week interval in-between the sessions. Laser energy was delivered in non-ablative way using Erbium SMOOTH™ mode technology and a 4-mm thick cannula. Therapeutic efficacy was determined using ICIQ-SF, the 1-hour pad test and VAS scores. Occurrence of adverse effects was followed at every visit. Follow ups (FU) were at 3 and 6 months. RESULTS: 29 female patients fulfilling the inclusion criteria were included in this pilot study and received two sessions of the intraurethral non-ablative Erbium SMOOTH™ laser therapy. Significant improvement was observed in all measured parameters at both FU. ICIQ-SF improved by an average of 64% at 3 months FU and by 40% at 6 months. The 1-hour pad test showed a reduction of the quantity of leaked urine by 59% at 3 months FU and by 42% at 6 months FU. All urinary symptoms of GSM improved. Dysuria dropped to 13% and 31% of baseline values at three and 6 months respectively, urinary urgency dropped to 23% and 47% and frequency dropped to 22% and 43% after 3 and 6 months, respectively. Adverse effects were mild and transient. CONCLUSIONS: Our findings suggest that intraurethral Er:YAG laser is an efficacious and safe modality for treatment of urinary symptoms of GSM, however, prospective, randomized, and controlled trials with larger number of patients are needed to better assess the long-term effect of this novel procedure. Lasers Surg. Med. 50:802-807, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Comparisons of treatment optimization directly incorporating systematic patient setup uncertainty with a margin-based approach.

PURPOSE: To develop a probabilistic treatment planning (PTP) method which is robust to systematic patient setup errors and to compare PTP plans with plans generated using a planning target volume (PTV) margin optimized to give the same target coverage probability as the PTP plan. METHODS: Plans adhering to the RTOG-0126 protocol are developed for 28 prostate patients using PTP and margin-based planning. For PTP, an objective function that simultaneously considers multiple possible patient positions is developed. PTP plans are optimized using clinical target volume (CTV) structures and organ at risk (OAR) structures. The desired CTV coverage probability is 95%. Plans that cannot achieve a 95% CTV coverage probability are re-optimized with a desired CTV coverage probability reduced by 5% until the desired CTV coverage probability is achieved. Margin-based plans are created which achieve the same CTV coverage probability as the PTP plans by iterative adjustment of the CTV-to-PTV margin. Postoptimization, probabilistic dose-volume coverage metrics are used to compare the plans. RESULTS: For equivalent target coverage probability, PTP plans significantly reduce coverage probability for rectum objectives (-17% for D(35) < 65 Gy, p = 0.0010; -23% for D(25) < 70 Gy, p < 0.0001; and -27% for D(15) < 75 Gy, p < 0.0001). Physician assessment indicates PTP plans are entirely preferred 71% of the time while margin-based plans are entirely preferred 7% of the time. CONCLUSIONS: For plans having the same target coverage probability, PTP has potential to reduce rectal doses while maintaining CTV coverage probability. In blind comparisons, physicians prefer PTP plans over optimized margin plans.

Disruptive Behavior in the Postdisciplinary Society.

Responding to disruptive behavior has become increasingly problematic in current Westernized societies, impacting people's well-being globally. In the context of the current Special Issue, in this article, we advance the concept of problematic disruptive behavior (PDB) as a suitable "window" to better understand some aspects of the deep interdependence of social participation, citizenship, justice, and well-being. To do so, we also advance the notion of postdisciplinary society to account both for the apparent rise of problematic disruptive experiences, and the increased social conflict within which such experiences get often entangled. More specifically, we argue that formerly morally acceptable responses to problematic disruption, such as punishment and discipline, have lost social legitimacy and, to that extent, they aggravate the problems they were intended to resolve. We provide a genealogical account of the surge of such postdisciplinary order with a focus on the moral transition on ideas of justice, of personal entitlements, and authority. We conclude outlining an alternative way to respond to disruptive behaviors that we anticipate will be both more effective and acceptable in the current postdisciplinary milieu.

Thrombotic microangiopathy after allogeneic blood and marrow transplantation is associated with dose-intensive myeloablative conditioning regimens, unrelated donor, and methylprednisolone T-cell depletion.

BACKGROUND: Allogeneic blood and marrow transplantation (BMT)-associated thrombotic microangiopathy (TM) contributes to transplant-related morbidity and mortality. This report examines the incidence of and risk factors for allogeneic BMT-associated TM in two patient cohorts treated before and after changes in myeloablative conditioning regimen intensity (high vs. standard intensity). METHODS: Cohort 1 includes 153 consecutive allogeneic BMT patients who underwent transplantation between April 1994 and October 1997 with an allogeneic BMT-associated TM crude incidence of 12%. Cohort 2 includes 75 consecutive allogeneic BMT patients who underwent transplantation from November 1997 to November 2000 with an allogeneic BMT-associated TM crude incidence of 1%. RESULTS: In cohort 1, matched unrelated donor transplant and methylprednisolone (MP) T-cell depletion (TCD) of donor bone marrow were significantly associated with allogeneic BMT-associated TM by univariate analysis; therefore, a logistic model incorporating these effects was constructed to calculate the expected number of allogeneic BMT-associated TM cases in cohort 2. Seven cases would have been expected, but only one was observed (P = 0.003; bayesian predictive test). The multivariate analysis of both cohorts yielded MP-TCD (P<0.001), high-intensity myeloablative conditioning regimens used in cohort 1 (P = 0.02), and matched unrelated donor (P = 0.03) as significant predictors of time to allogeneic BMT-associated TM. CONCLUSION: Avoidance of high-intensity conditioning regimens may decrease the incidence of allogeneic BMT-associated TM.

[Antioxidant power and cellular damage in prostate cancer]. / Poder antioxidante y daño celular en el carcinoma de próstata.

OBJECTIVES: To determine and compare the antioxidant power, cellular damage by lipidic peroxidation, and membrane damage in normal patients and patients with prostate cancer, so determining the antitumoral capacity. METHODS: The study population included 19 patients with elevated total PSA, greater than 4 ng/ml, with a minimum of 10 ultrasound guided transrectal biopsies, and 10 normal subjects as control group. In all cases, medical history, rectal digital examination, PSA determination and routine analyses were performed in addition to spectrophotometric tests to measure the antioxidant power. Membrane damage was measured by determination of malonyldialdehyde (MDA) and cellular damage by glutathione peroxidase. RESULTS: From a total of 19 cases: 6 (31.5%) presented prostate cancer (4 Gleason 7; 1 Gleason 6 and 1 Gleason 8); 8 presented histological benign prostatic hyperplasia with a component of chronic prostatitis; 3 patients prostatic hyperplasia and glandular atrophy; and 2 cases isolated benign prostatic hyperplasia. All 10 control patients presented values within normal range in all determinations, whereas study patients showed antioxidant power < 1.3 mmol/l in 13 cases; higher than 1.77 mmol/l in 4 and normal values in 2. MDA was elevated in 15 patients and normal in 4, all of them without histological chronic prostatitis. Four of the patients with prostate cancer presented a diminished antioxidant power below 0.90, with a relationship with glandular architecture, because those with Gleason 8 and 7 did not exceed 0.58 mmol/l. Two patients with prostate cancer with a lower Gleason score presented normal minimal values. CONCLUSIONS: Patients with prostate cancer or reactive processes, such as chronic prostatitis or atrophic prostatitis, present a decreased antioxidant power and an increase of lipidic peroxidation.

La ensenanza de la cirugia en Colombia / Teaching surgery in Colombia

Se exponen serios argumentos de orden academico y docente para sustentar el programa de adiestramiento en cirugia general en 4 anos, a fin de formar un cirujano integral con solidos conocimientos en ciencias basicas que lo estructuren suficientemente para tomar decisiones bien elaboradas y altamente eticas. Se comenta el enfoque multidisciplinario de esta actividad quirurgica, que la vincula a otras especialidades medico-quirurgicas, y de la cual forman parte, ademas, varias sub-especialidades. Se mencionan los componentes curriculares de un programa de cirugia general con sus interrelaciones mas estrechas. Se hace un comentario en relacion con la calidad de los programas de la especialidad, actualmente vigentes en nuestras Facultades de Medicina. Se analizan las perspectivas de la saturacion relativa de cirujanos generales, que ha motivado dificultades en el mercado laboral para algunos especialistas; y al respecto, se propone la ejecucion de estudios tecnicos sobre la demanda real de recursos humanos en esta area

Infarto del miocardio: diez años de seguimiento / Myocardium infarction: a 10 year follow-up

Con el objetivo de conocer algunos aspectos de su evolución, fueron seguidos durante 10 años 80 pacientes egresados del Instituto Superior de Medicina Militar con diagnóstico de infarto cardíaco agudo. Se examinaron en consultas especializadas cada 3 meses, al final del estudio se les realizó examen clínico y de laboratorio, y se interrogó a familiares o testigos de los fallecidos. Fue conocido el estado del 100 % de los pacientes. La mortalidad a los 10 años fue de un 57,50 %, baja al inicio, y se incrementó del quinto al séptimo, decreciente a partir del octavo y variable entre éste y el décimo año. El reinfarto constituyó la principal causa de muerte. Algunas variables influyentes en la mortalidad en los primeros años como son: el sexo masculino, el hábito de fumar, la hipercolesterolemia y la cardiomegalia no pierden su valor como elemento influyente importante al final del estudio. Al cabo de 10 años mantienen su actividad habitual el 53,0