RESUMEN
BACKGROUND: Waterjet dissection has been proposed for total mesorectal excision. The present study investigated its impact on urodynamic function and oncological outcome. METHODS: Thirty patients with rectal cancer were recruited to this prospective study, of whom 25 underwent urodynamic evaluation both before and after surgery. RESULTS: All patients were capable of spontaneous micturition at a median of 5 months after surgery. Urodynamic measurements revealed a decrease in detrusor pressure of more than 30 mmHg, and residual urine volumes of between 100 and 200 ml, in three patients. No patient had a complete neurogenic voiding disorder. Local recurrences developed in two of 22 patients. CONCLUSION: The extent of micturition disorders observed after total mesorectal excision using the waterjet method in this small series is encouraging.
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Colectomía/instrumentación , Neoplasias del Recto/cirugía , Vejiga Urinaria/fisiopatología , Urodinámica/fisiología , Agua , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias del Recto/fisiopatologíaRESUMEN
Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.
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Two genes, namely p27Kip1 and p21WAF/Cip1 that reveal distinct structural homology, have been identified as inductors of cell cycle arrest at the G1-checkpoint to prevent entry of somatic cells into the S phase of the cell cycle when substantial DNA damage has occurred. It was demonstrated that the p21WAF/Cip1 gene is induced by pathways dependent and independent from a functionally intact p53 tumour suppressor protein. It has been suggested that decreased expression both of the p21WAF/Cip1 and p27Kip1 protein may contribute to the development of human malignancies due to loss of critical antiproliferative mechanisms. So far, the role of altered p21WAF/Cip1 and mainly of a decreased p27Kip1 protein expression in patients with muscle invasive bladder cancer has not been investigated. In the present study, 50 tumour specimens from 50 patients undergoing radical cystectomy (T2-T4) were investigated for different biological and clinical characteristics as possible prognostic factors: age, depth of tumour infiltration (T-stage), histological grading (G), lymph node status as well as immunohistochemical staining for the p21WAF/Cip1 and p27Kip1 proteins. The median recurrence-free survival for patients with and without retained p21WAF/Cip1 protein expression was 54 months (3-86 months) and 13 months (1-40 months), respectively (p=0.07). During univariate analysis, loss of p21WAF/Cip1 protein expression (p=0.02), T-stage (p=0.02) and histological grading (p=0.03) were significant prognostic factors for survival, among which a negative reaction for the p21WAF/Cip1 protein (p=0.02) as well as T-stage (p=0.005) remained independent significant predictors during multivariate analysis. Loss of p27Kip1 protein expression was not correlated with the recurrence-free or the overall survival of the patients. Prospective studies are needed to confirm the independent prognostic potential of cell-cycle associated proteins such as p21WAF/Cip1 in patients with muscle invasive bladder cancer. The availability of more refined prognostic factors should assist decision making regarding the value of more aggressive treatment options, such as adjuvant or neoadjuvant chemotherapy, for defined subgroups of patients.
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Proteínas de Ciclo Celular , Ciclinas/biosíntesis , Proteínas Asociadas a Microtúbulos/biosíntesis , Proteínas Supresoras de Tumor , Neoplasias de la Vejiga Urinaria/metabolismo , Neoplasias de la Vejiga Urinaria/patología , Adulto , Anciano , Anciano de 80 o más Años , Inhibidor p21 de las Quinasas Dependientes de la Ciclina , Inhibidor p27 de las Quinasas Dependientes de la Ciclina , Cistectomía , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
As the incidence of toxoplasma encephalitis (TE) in AIDS patients increases, sulfadiazine/pyrimethamine combination therapy is broadly administered. Two cases of acute and chronic renal sulfadiazine crystallization with acute renal failure and nephrolithiasis are reported. Controlled alkalinization of the urine and high fluid intake are recommended for prophylaxis of crystalluria.
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Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Lesión Renal Aguda/inducido químicamente , Cálculos Renales/inducido químicamente , Sulfadiazina/efectos adversos , Toxoplasmosis Cerebral/tratamiento farmacológico , Adulto , Quimioterapia Combinada , Humanos , Masculino , Pirimetamina/uso terapéutico , Sulfadiazina/uso terapéuticoRESUMEN
A multicenter long-term study at 13 urologic clinics in Germany and Austria tested the efficacy and safety of a papaverine (15 mg/ml) and phentolamine (0.5 mg/ml) mixture (ANDROSKAT) in achievement of pharmacologically aided erection. The study population of 157 men with chronic erectile dysfunction received a total of 559 injections administered by physicians, to establish the individual minimal dose of the mixture needed by each patient for a rigid erection. Rigidity sufficient for intercourse was achieved by 94% of these men. In the second phase of the study, 92 men administered a total of 4717 self-injections (mean 51.2, SD 7.7), with an average follow-up of 14 months. The mean therapeutic dose was 1.02 ml (SD 0.72). The latency time to full erection averaged 10.3 min (SD 5.5). The average duration of the erection induced was 67.1 min (SD 40.8, min. 11.2, max. 236). Sexual intercourse, orgasm and ejaculation were reported following 90%, 88% and 86%, respectively, of all injections. In the initial diagnostic phase, prolonged erections were seen in 13 patients (3%) and minor bruises at the injection site in 12 men. Side effects of self-injection during home therapy were pain (1.2%), haematoma (2.6%) and prolonged erection (0.9%). We conclude that self-injection with a combination of papaverine and phentolamine is an efficient and safe long-term treatment for erectile dysfunction.
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Disfunción Eréctil/tratamiento farmacológico , Papaverina/efectos adversos , Fentolamina/efectos adversos , Adulto , Anciano , Quimioterapia Combinada , Eyaculación/efectos de los fármacos , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Orgasmo/efectos de los fármacos , Papaverina/administración & dosificación , Erección Peniana/efectos de los fármacos , Fentolamina/administración & dosificación , Vigilancia de Productos Comercializados , AutoadministraciónRESUMEN
The results of clinical evaluation of 71 patients with primary or secondary enuresis are presented. In 66 patients a complete urodynamic assessment was possible. 35 percent of these patients showed a normal urodynamic pattern, in 45 percent detrusor hyperreflexia and in 18 percent a combination of detrusor hyperreflexia and a functional infravesical obstruction was demonstrated.
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Enuresis/etiología , Urodinámica , Adolescente , Adulto , Niño , Preescolar , Electromiografía , Enuresis/fisiopatología , Femenino , Humanos , Masculino , Manometría , Músculos/fisiopatologíaRESUMEN
A case of segmental priapism in a 24-year-old man with congenital spherocytosis is presented. Preoperative cavernosography and computer tomography clearly revealed thrombosis of the left proximal corpus cavernosum. Because the lesion had already been in existence for 5 weeks irrigation to flush out the thrombosis was no longer possible.
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Priapismo/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Priapismo/diagnóstico por imagen , Priapismo/cirugía , Neoplasias Testiculares/diagnóstico , Testículo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Claims for compensation following dissatisfaction with the results of medical treatment have increased in frequency over the last few years. Medical records, such as declarations of consent and operation reports, often constitute important evidence in legal proceedings, particularly in the field of surgery. Before a vasectomy is performed for the purpose of contraception, detailed information must be given on how safe this is as a method of birth control and the patient must be made aware of the importance of sperm count controls after the operation. The surgeon is held responsible if it can be shown that a failed sterilization is due to ligation of only one vas deferens or to failure to notice an accessory one. Claims for compensation can include support for children up to the age of 18 years and financial compensation to the mother in respect of the labour pains.
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Consentimiento Informado/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Educación del Paciente como Asunto/legislación & jurisprudencia , Complicaciones Posoperatorias/etiología , Vasectomía/métodos , Humanos , Responsabilidad Legal , MasculinoRESUMEN
Ureteral stump metastasis after tumor nephrectomy is very rare. To date 43 cases have been published. In our patient this type of metastasis was diagnosed 2 years after nephrectomy for renal adenocarcinoma with prominent rhabdomyosarcomatoid components. The pathogenesis of ureteral stump metastasis is discussed.
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Carcinoma de Células Renales/secundario , Neoplasias Renales/cirugía , Nefrectomía , Complicaciones Posoperatorias/cirugía , Neoplasias Ureterales/secundario , Adrenalectomía , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Humanos , Riñón/patología , Neoplasias Renales/patología , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Uréter/patología , Neoplasias Ureterales/patología , Neoplasias Ureterales/cirugíaRESUMEN
Since penile vein ligation is usually associated with a poor postoperative outcome, a study was undertaken to evaluate possible prognostic factors for this procedure. A total of 44 patients with erectile dysfunction underwent ligation of all dorsal penile veins and resection of the deep dorsal penile vein for venous impotence. A comprehensive study of all patients was made. All patients did not respond to pharmacotherapy and had a venous leak. With a minimum follow-up period of 6 months, patients were categorized as follows: full spontaneous erections, those patients responding to pharmacotherapy and those showing no improvement. Out of 44 patients, 13 had full spontaneous erections postoperatively, 5 now responded to pharmacotherapy and 26 showed no improvement. The maintenance flow was 89 +/- 50 ml/min in the group with spontaneous erections and 85 +/- 49 ml/min in those showing no improvement (P = 0.78). Out of the 20 patients with normal single potential analysis of cavernous electric activity (SPACE), 12 had full erections postoperatively, 4 showed no improvement and 4 responded to pharmacotherapy. Of the 24 patients with abnormal SPACE, 1 developed full erections, 1 now responds to pharmacotherapy and 22 showed no improvement. Our results indicate that SPACE seems to be an important prognostic factor for the postoperative outcome of penile vein ligations for venous impotence.
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Disfunción Eréctil/cirugía , Insuficiencia Venosa/cirugía , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Disfunción Eréctil/diagnóstico por imagen , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Papaverina/administración & dosificación , Pene/irrigación sanguínea , Fentolamina/administración & dosificación , Complicaciones Posoperatorias/etiología , Ultrasonografía , Venas/diagnóstico por imagen , Venas/cirugía , Insuficiencia Venosa/complicaciones , Insuficiencia Venosa/diagnóstico por imagenRESUMEN
We report on a patient with the diagnosis of an adult teratoma metastasizing as choriocarcinoma. The 49-year-old man died of dysfunction of the liver caused by massive metastatic involvement. This case demonstrates the malignant potential of adult teratoma and emphasizes the need for chemotherapy of the same kind as for other malignant germ cell tumours if undifferentiated metastases of the teratoma are present. The chemotherapeutic modalities and the options for surgical treatment of metastatic adult teratomas of the testis are discussed.
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Carcinoma de Células Escamosas/cirugía , Coriocarcinoma/secundario , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/cirugía , Neoplasias Primarias Secundarias/cirugía , Neoplasias Testiculares/cirugía , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Coriocarcinoma/tratamiento farmacológico , Coriocarcinoma/patología , Coriocarcinoma/cirugía , Terapia Combinada , Diagnóstico Diferencial , Humanos , Hígado/patología , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Pulmón/patología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias/tratamiento farmacológico , Neoplasias Primarias Secundarias/patología , Orquiectomía , Neumonectomía , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/patología , Testículo/patologíaRESUMEN
Between February 1985 and January 1987, 186 patients with erectile dysfunction were selected for cavernosal autoinjection therapy (CAT). After more than 4800 protocolled autoinjections and 10-230 CAT/pt., no cavernous fibrosis, penile deviation or cavernitis occurred. The only serious side effects were prolonged erections in about 10% during diagnostic and less than 1% during therapeutic use. These prolonged erections could be easily treated by puncture and aspiration of corpora cavernosa or intracavernosal injection of Metaraminol.
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Disfunción Eréctil/tratamiento farmacológico , Papaverina/administración & dosificación , Fentolamina/análogos & derivados , Quimioterapia Combinada , Humanos , Inyecciones , Masculino , Metaraminol/administración & dosificación , Erección Peniana/efectos de los fármacos , Pene/efectos de los fármacos , Fentolamina/administración & dosificaciónRESUMEN
In 25-30% of the patients with erectile dysfunction, venous insufficiency is the (additional) reason for the erectile failure. Surgical procedures and prognosis depend largely on the precise localisation of the pathological drainage. The venous leakage is proven and exactly localized by a multiprojectional cavernosography, measurement of the maintainance flow and intracavernous pressure monitoring. The most reliable screening test for venous erectile dysfunction is the intracavernous application of a standardised vasoactive drug combination.
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Disfunción Eréctil/etiología , Pene/irrigación sanguínea , Insuficiencia Venosa/complicaciones , Humanos , Masculino , Erección Peniana , Flebografía , Reología , Presión VenosaRESUMEN
INTRODUCTION: Testicular trauma can be classified into blunt or penetrating injury. While every case of penetrating trauma is subjected to surgical treatment, the decision between surgery and conservative treatment must be made for each case of blunt injury. Inspection, palpation and duplex sonography may be helpful in finding the correct decision. Herein we present a case report and review of the current literature. CASE REPORT: A 14-year-old boy was admitted to an urological department after blunt scrotal trauma. Ultrasound examination revealed a peritesticular hematoma. After 9 days of conservative treatment, surgical exploration and orchidectomy for rupture of the tunica albuginea was performed. CONCLUSIONS: The following recommendations can be made for treatment of blunt testicular injury: if rupture of the testis is detected sonographically, immediate surgical exploration is indicated. Every change in testicular structure must be considered a possible sign of testicular rupture. Sonographically detected hematoceles without visible signs of rupture are not given clear recommendations in the literature. However, early surgical intervention (within 72 hours) seems to increase the likelihood of preserving the testis. In every case of unclear clinical or sonographic findings, surgical exploration of the scrotum should be done. If offers a safe and quick diaganosis with a very low complication rate.
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Orquiectomía , Testículo/lesiones , Heridas no Penetrantes , Adolescente , Humanos , Masculino , Rotura , Testículo/diagnóstico por imagen , Testículo/cirugía , Factores de Tiempo , Ultrasonografía , Heridas no Penetrantes/cirugía , Heridas no Penetrantes/terapiaRESUMEN
In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.
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Anastomosis Quirúrgica/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Derivación Urinaria/estadística & datos numéricos , Neoplasias Urogenitales/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
The implantation of metal stents in the ureter is an alternative therapeutic option for treating ureteral strictures of different origins. We report the case of a female patient who was treated with a ureteral wall stent because of stenosis caused by radiotherapy. Subsequently the stent migrated into the bladder and led to incrustation and stone formation. This finally led to development of a vesicovaginal fistula and bladder perforation into the os pubis.
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Migración de Cuerpo Extraño/etiología , Complicaciones Posoperatorias/etiología , Hueso Púbico , Sínfisis Pubiana , Stents/efectos adversos , Obstrucción Ureteral/terapia , Cálculos de la Vejiga Urinaria/etiología , Vejiga Urinaria , Fístula Vesicovaginal/etiología , Absceso Abdominal/diagnóstico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Anciano , Femenino , Migración de Cuerpo Extraño/diagnóstico , Migración de Cuerpo Extraño/cirugía , Humanos , Hidronefrosis/terapia , Procesamiento de Imagen Asistido por Computador , Nefrostomía Percutánea , Osteomielitis/diagnóstico , Osteomielitis/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Hueso Púbico/lesiones , Hueso Púbico/patología , Hueso Púbico/cirugía , Sínfisis Pubiana/lesiones , Sínfisis Pubiana/patología , Sínfisis Pubiana/cirugía , Recurrencia , Retratamiento , Tomografía Computarizada por Rayos X , Vejiga Urinaria/lesiones , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Cálculos de la Vejiga Urinaria/diagnóstico , Cálculos de la Vejiga Urinaria/cirugía , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirugíaAsunto(s)
Analgésicos , Trasplante de Riñón , Trastornos Relacionados con Sustancias/complicaciones , Neoplasias Urológicas/epidemiología , Anciano , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Urológicas/inducido químicamenteRESUMEN
In addition to neuropediatrical, neurosurgical and orthopedical care a continuous urological surveillance is indicated in children with myelodysplasia. Urodynamic assessment, voiding cystourethrography, kidney- and residual urine, ultrasound, excretory urography and radioisotope studies at birth and periodically until puberty are performed to evaluate the urinary tract. Early and specific treatment of bladder dysfunction is necessary to prevent urinary infection and preserve renal parenchyma. Urodynamic testing showed evidence of neurogenic bladder dysfunction in 13 of 14 evaluated children (including 8 newborns): detrusor-sphinkter-dyssynergia in 57 percent, detrusor hyperreflexia in 21 percent and detrusor areflexia in 14 percent. 4 of 5 children with detrusor-sphkincter-dyssynergia were treated effectively with anticholinergic agents and clean intermittend catheterization.
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Meningomielocele/complicaciones , Vejiga Urinaria Neurogénica/etiología , Reflujo Vesicoureteral/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Pruebas de Función Renal , Masculino , UrodinámicaRESUMEN
The aim of this study was to determine and compare the effects of both magnesium citrate and phytin on reducing urinary calcium excretion under high-calcium-diet conditions during single and combined treatments. An animal experiment was carried out over a period of 4 weeks in 35 male rats. Urinary calcium excretion was reduced significantly by magnesium citrate and/or phytin in rats fed on high-calcium diets. The hypocalciuric effect of magnesium citrate was more evident than that of phytin. Urinary magnesium excretion was high in all experimental groups. However, the urinary magnesium/calcium ratios showed a consistent increase only in the groups treated with magnesium citrate. Urinary citrate excretion showed a relative increase with the introduction of magnesium citrate plus phytin; however, in both the high-calcium-diet group and the magnesium-citrate group this was found to be reduced. Urinary phosphate excretion was slightly higher in the groups treated with phytin. There was no definite difference in urinary oxalate concentration between the groups. No significant change was noted in the serum concentration of calcium, magnesium, or phosphate.