[Photoselective vaporization of the prostate with Laser Greenlight HPS: current role, technical aspects and review of the literature]. / Papel actual de la fotovaporización prostática con Láser Greenlight HPS. Aspectos técnicos y revisión de la literatura.

Photoselective vaporization of the prostate with 120W HPS Greenlight laser is one of the most attractive modalities of surgical treatment for benign prostatic hyperplasia at present. The specific physical characteristics of this laser provides an excellent safety and effectiveness profile, making it the ideal technique for high-risk patients or patients ongoing oral anticoagulation. Moreover, the undeniable reduction of urethral catheterization time and hospital stay compared to transurethral resection of prostate (TURP) involves a much more comfortable postoperative period for patients. We have conducted a Medline/Pubmed search, presenting in this review the outcomes and current surgical techniques described in recent studies. We have also reviewed the controversial aspects and limitations attributed to this technique.

The surface modification of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) copolymers to improve the attachment of urothelial cells.

Biocompatible and biodegradable poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) [P(HB-co-HHx)] substrates were modified to improve the attachment of porcine urothelial cell culture. The pristine copolymer exhibits excellent mechanical properties to replace the bladder tissue, but its surface lacks chemical functionalities to interact with cells. Thus, wet chemical treatments based on NaOH and ethylenediamine in aqueous [ED(aq)] and isopropanol [ED(isoOH)] media to functionalize the P(HB-co-HHx) films surfaces were compared. Among these treatments, short ED(aq) treatment was able to decrease the hydrophobicity, rendering a surface with amino groups and without a significant alteration of the mechanical properties. Furthermore, to enhance the interaction with urothelial cells, laminin derived YIGSR sequence was covalently bound to these amino functionalized substrates. The focal attachment was clearly improved with this last treatment, comparing with those results found with the unmodified and first-step functionalized P(HB-co-HHx).

Surface modification of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) copolymer films for promoting interaction with bladder urothelial cells.

Often bladder dysfunction and diseases lead to therapeutic interventions that require partial or complete replacement of damaged tissue. For this reason, the development of biomaterials to repair the bladder by promoting the adhesion and growth of urothelial cells is of interest. With this aim, a modified copolyester of biocompatible and biodegradable poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [P(HB-co-HV)] was used as scaffold for porcine urothelial cell culture. In addition to good biocompatibility, the surface of P(HB-co-HV) substrates was modified to provide both, higher hydrophilicity and a better interaction with urothelial cells. Chemical treatments with ethylenediamine (ED) and sodium hydroxide (NaOH) led to substrate surfaces with decreasing hydrophobicity and provided functional groups that enable the grafting of bioactive molecules, such as a laminin derived YIGSR sequence. Physico-chemical properties of modified substrates were studied and compared with those of the pristine P(HB-co-HV). Urothelial cell morphology on treated substrates was studied. The results showed that focal attachment and cell-related properties were improved for peptide grafted polymer compared with both, the unmodified and functionalized copolyester.

[Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux]. / Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario.

OBJECTIVES: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. METHODS: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. RESULTS: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. CONCLUSIONS: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This conclusion cannot be applied on endoscopic treatment.

[Abdominal compartment syndrome in an urological patient]. / Sindrome compartimental abdominal en un paciente urológico.

OBJECTIVES: Abdominal compartment syndrome is an infrequent clinical entity, the course of which has a rapid progression with multiorgan compromise leading to a fatal outcome if appropriate and urgent action is not undertaken. METHODS AND RESULTS: We report the clinical case of a patient who developed the clinical picture after renal trauma. Diagnosis was obtained by CT scan and arteriography, afterwards the patient required ICU admission with intra-abdominal pressure monitoring, and several decompression laparotomies before definitive closure with a reabsorbable mesh. CONCLUSIONS: Urologists should know the existence of this syndrome its appropriate treatment, because we manage patients who are candidates to suffer it. Due to the high mortality rate associated, it is essential to know how to recognize it in order to act fast.

[Collecting duct carcinoma. Personal experience and review of the literature]. / Carcinoma de los conductos colectores. Experiencia personal y revisión de la literatura.

OBJECTIVE: To present our experience with renal collecting duct carcinoma and review the literature. METHODS: We reviewed our experience with collecting duct carcinoma of the kidney. We found 6 cases out of 176 nephrectomies (3.4%), which accounts for one of the largest series reported in the literature. The radiological, histological and immunohistochemical findings are analyzed. RESULTS: The histological and immunohistochemical findings showed a specificity for high molecular weight cytokeratins and Ulex europeaeus but the imaging findings were not distinct from those of other renal tumors. According to the anatomopathological findings, we have classified the patients into three groups with three distinct courses. All patients underwent radical nephrectomy and one patient received adjuvant therapy. CONCLUSIONS: We have identified a subgroup of low grade collecting duct carcinoma of the kidney with a particularly favorable behavior in two patients of our series. At 56 and 41 months' follow-up, both patients remain disease-free. As reported in the literature, patients with high grade and stage collecting duct carcinoma of the kidney have a poor outcome. They develop severe complications and die less than one year after the diagnosis, despite adjuvant immunotherapy.

[Difficulties in the treatment of symptomatic varicocele using percutaneous embolization: the circumaortic renal vein]. / Dificultades en el tratamiento del varicocele sintomático mediante embolización percutánea: la vena renal circumaórtica.

OBJECTIVE: The anatomic anomalies of the inferior cava and its collaterals, even though they do not normally show symptoms, can cause difficulties in different diagnostic and therapeutic procedures, such as the percutaneous treatment by gonadal embolization of the varicocele. METHODS: We analyzed the incidence of one of these anomalies, specifically the left circumaortic renal vein, in a series of 50 gonadal embolization procedures for symptomatic varicocele. RESULTS: We found two cases (4%) of left circumaortic renal vein in our series. Gonadal embolization was possible in only one of the cases since the ostium of the gonadal vein could not be localized in the other case. In the first case, the gonadal ostium was in the paraaortic confluence of the venous ring, and could be catheterized and selectively embolized. CONCLUSIONS: The presence of a circumaortic left renal vein can make it technically impossible to perform embolization of the symptomatic varicocele.