Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate.

INTRODUCTION AND AIM: Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. MATERIAL AND METHODS: A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. RESULTS: A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. CONCLUSIONS: Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery.

INTRODUCTION: Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. MATERIAL AND METHODS: Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. RESULTS: A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). CONCLUSION: PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.

The complications of the HoLEP learning curve. A systematic review. / Análisis de las complicaciones en el aprendizaje del HoLEP: revisión sistemática.

BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) could have better outcomes with decreased complication rates if compared to traditional techniques (transurethral resection and open prostatectomy) for the surgical relief of bladder outlet obstruction. Despite this, its use has not been implemented in the urology community, probably due to the high complication rates of the HoLEP learning curve (HoLC). OBJECTIVE: To conduct a systematic review of the complication rates in HoLC and compare these with those of traditional techniques. EVIDENCE ACQUISITION: a systematic literature search was performed in MedLine and Embase using the search terms «HoLEP¼ and «holmium laser enucleation¼. We identified 680 records and selected 15 studies following PRISMA criteria. EVIDENCE SYNTHESIS: 1705 cases in the learning curves of 59 surgeons were analyzed. Most of the studies do not report complications in a standardized way. Intraoperative complication rates are low and usually without long-term impact. Postoperative complication rates are limited and show improvement with practice. The complication rates in the HoLC are similar or lower to those reported by traditional techniques. CONCLUSION: Complication rates in HoLC are not higher than those reported by traditional techniques. HoLEP learning should not be delayed for fear of increasing complications or their severity.

[Cystic lymphangioma. Our experience]. / Linfangioma quístico. Nuestra experiencia.

OBJECTIVE: To comment on the most relevant aspects and to review the literature on this unusual pathology. MATERIAL AND METHODS: We present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum. DISCUSSION: Cystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed. CONCLUSIONS: There are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma.

[Isolated intraepithelial prostatic neoplasia and positive prostate adenocarcinoma results at repeated biopsy. Review of our series]. / Neoplasia intraepitelial prostática aislada y positividad para adenocarcinoma en la rebiopsia. Revision de nuestra serie.

OBJECTIVE: To review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literature. MATERIALS AND METHODS: We review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN (HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them. RESULTS: The diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0.52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from 3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88). The median PSA value of the studied cases was 9.8 ng/ml. The Gleason score of the positive biopsies was always between 3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies. CONCLUSIONS: In spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy (43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients.

[Accidentally diagnosed hypernephromas. Retrospective study and evaluation of their importance in clinical practice]. / Hipernefromas de diagnóstico accidental. Estudio retrospectivo y evaluación de su importancia en la práctica clinica.

Presentation of a retrospective study on 50 hypernephromas seen in our service, including an evaluation of those that were accidentally diagnosed. Nineteen of these were diagnosed by chance and 9 as a result of other investigations required for the study of a gastrointestinal disease, these studies being in most cases an ultrasound recording. Data obtained with this review allows us to compare these results with those from other authors, as well as to evaluate the relevance of such diagnoses in the daily clinical practice. The study concludes that the fact that these tumours are found in earlier stages is more than enough to raise questions on the way in which we could increase the number of this chance diagnosis.

[Surgical renal biopsies: technique, effectiveness and complications]. / Biopsias renales quirúrgicas: técnica, efectividad y complicaciones.

Retrospective study made on 140 renal surgical biopsies (RSB) performed throughout the past 4 years in our Unit. The technique's effectiveness and morbidity are emphasized and the surgical technique and type of anaesthesia described. The sample obtained was enough to perform an essay in 100% cases, and a diagnosis was reached in 98.5%. Thirty-nine patients (27.8%) presented complications, 13 (9.2%) of which were directly related to the surgical technique. No case required blood transfusion and no deaths were reported. The type of anaesthesia used was: local plus sedation in 104 (74.2%) cases, rachianaesthesia in 10 (7.1%) and general in 26 (18.5%). The same approach was used in all patients: minimal subcostal lumbotomy, using Wilde's forceps to obtain the samples. It is believed that RSB is a highly effective, low mortality procedure, easy and quick to perform, and suitable for selected patients.

[Malignant mesothelioma of the tunica vaginalis]. / Mesotelioma maligno de túnica vaginal.

Case report of a new case of malignant mesothelioma of the tunica vaginalis testis. A mediterranean male age 62, presented with enlargement and swelling of the scrotum, treated as orchiepydidymitis within the previous 3 months. Physical and ultrasonography examination showed a left scrotal mass with extension to the skin of the scrotum. After surgery (orchiectomy and partial hemiscrotectomy) and histopathology diagnosis of locally advanced malignant mesothelioma, CT showed metastasis in retroperitoneum, Lung and Liver. The patient undergoes chemotherapy and radiotheraphy with a poor prognose. We review the diagnosis, histopathology and therapeutical approach for this uncommon kind of paratesticular tumor (less than 80 cases reported in the last 30 years).

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

[Sclerosing treatment of hydrocele]. / Tratamiento esclerosante del hidrocele.

We present the results of treatment with aspiration and tetracycline sclerotherapy of 24 cases of hydrocele with a follow-up of 9 months. Only minor complications were observed and the cure rate was less than 50%. The indications of this therapeutic modality versus surgery are discussed.

[New compound needle for percutaneous renal puncture]. / Nueva aguja compuesta para la punción renal percutánea.

OBJECTIVE: We have developed a needle for direct percutaneous access in order to introduce the flexible wire with a single puncture, without creating two parallel tracks, thereby affording a lower morbidity than the conventional technique. METHOD: The needle consists of an internal and an external device, with different lengths and diameters, that let us first create the access to the urinary tract with the inner device and then dilate with the outer device in order to introduce the metallic wire with a single puncture, sliding the outer over the inner device. RESULTS: We can achieve the same number of percutaneous accesses with less morbidity since less punctures are required to create the track. CONCLUSION: This is a useful needle for any type percutaneous access.

[Simplified vasovasostomy]. / Vaso-vasostomía simplificada.

OBJECTIVES: A simplified technique to repair seminal duct obstruction is described. METHODS: Optical magnification, a channeled instrument as a suture guide that we have developed and fibrin glue are utilized. RESULTS: This technique is safe, reduces operating time and achieves similar results as with a surgical microscope. CONCLUSIONS: This technique facilitates repair of small caliber structures, reduces the operating time and does not require large microscopic systems.

[Barcelona pouch. An external continent urinary diversion]. / Barcelona Pouch. Una derivación urinaria externa continente.

OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.

[Renal biopsy of nephrologic origin. Report of 283 biopsies]. / Biopsia renal de causa nefrológica. A propósito de 283 biopsias.

Two techniques are utilized for renal biopsy (RB): open renal biopsy (ORB) and percutaneous renal biopsy (PRB). We reviewed 283 renal biopsies: 140 ORBs and 143 PRBs. The number of glomeruli obtained were 34.6 and 13.4, respectively. Sufficient biopsy material for the pathological analyses was obtained in 100% of the ORBs and 91% of the PRBs. These were diagnostic in 98.5% and 91%, respectively. The two groups were significantly different. Patients submitted to ORB had a worse general condition (analytically more uremic and anemic). The creatinine and urea values prior to RB were higher for the complicated ORB group versus the overall ORB group. Statistically, the complicated ORB group is related with hyperpotassemia and hypernatremia. The sodium values were higher and the urea values were lower for the complicated ORB group, although we believe the foregoing findings to have no clinical value. The remaining analytical studies were not different for the groups or subgroups of the present study.

[The therapeutic management of the rupture of a kidney graft]. / Actitud terapéutica ante la rotura del injerto renal.

From a consecutive series of 106 renal transplants, we present our experience on spontaneous renal allograft rupture. This complication appeared in 6 patients, which accounts for 5.6% of the overall group: four patients (66.6%) had acute rejection, two (33.3%) developed thrombosis of the renal vein (one of which coincided with rejection), and rupture was attributed to trauma in one patient (16.6%). Rupture was diagnosed within the first two weeks after transplant in five patients and on day 27 in one patient. The therapeutic approach was determined according to the cause of the rupture. In our view, nephrectomy is warranted in those cases with venous thrombosis and in acute rejection correction of hypovolemia and adequate immunosuppression are essential. Drainage of perirenal hematoma is the first step when conservative surgical treatment is required. We use three-dimensional renal corsetage with polyglycolic acid mesh (PAM) for hemostasis and to prevent expansion and fragmentation of the parenchyma. PAM is easy to handle and covers the kidney completely and uniformly. Two nephrectomies were carried out and in both cases thrombosis of the renal vein was diagnosed. PAM was placed in two cases: one with rejection and the other with trauma. The remaining two patients were managed conservatively due to the good response of rejection to immunosuppressor therapy and the patients response to medical treatment. There were no deaths and complications were observed in only one patient (16.6%). All patients with preserved transplant (66.6%) had a good course and renal function was preserved.