INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6â¯mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174â¯min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.
Rectal Fistula , Urethral Diseases , Urinary Fistula , Animals , Humans , Male , Middle Aged , Prostate , Prostatectomy/adverse effects , Rectal Fistula/etiology , Swine , Urethral Diseases/etiology , Urinary Fistula/etiology
Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)
Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)
Humans , Aged , Prostate , Prostatectomy/adverse effects , Rectal Fistula/etiology , Urethral Diseases/etiology , Urinary Fistula/etiology
INTRODUCTION: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. MATERIALS AND METHODS: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. RESULTS: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant differences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant differences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant difference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant differences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). CONCLUSION: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted.
Anesthesia, Local , Anti-Anxiety Agents/therapeutic use , Biopsy, Needle/psychology , Clorazepate Dipotassium/therapeutic use , Pain/prevention & control , Patient Acceptance of Health Care , Prostate/pathology , Administration, Topical , Adult , Aged , Anti-Anxiety Agents/administration & dosage , Benactyzine/administration & dosage , Benactyzine/analogs & derivatives , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Clorazepate Dipotassium/administration & dosage , Gels , Humans , Injections , Lidocaine/administration & dosage , Male , Middle Aged , Muscarinic Antagonists/administration & dosage , Pain/etiology , Pain Measurement , Prospective Studies , Prostate/diagnostic imaging , Surveys and Questionnaires , Ultrasonography, Interventional
Introducción: la biopsia prostática es un procedimiento molesto, lo que condiciona que constantemente intentemos disminuir el dolor durante su realización. Material y métodos: diseñamos un estudio prospectivo aleatorizado en el que incluimos 160 procedimientos. Criterios de inclusión: primera biopsia, antígeno prostático específico (PSA) < 15 ng/ml, edad menor de 75 años. Los pacientes fueron aleatorizados en 4 grupos. El primero (A) quedó como control, el B recibió anestesia intracapsular (8 ml de lidocaína 2%), el C 5 mg de clorazepato dipotásico vía oral una hora antes y en el D se aplicaron las dos medidas (anestesia local y clorazepato). Se entregó un cuestionario con tres medidas de dolor (valorándolo de 0 a 10) tras el procedimento y otro 30 minutos después. Resultados: las medias del dolor fueron 5,17 (A), 1,72 (B), 2,43 (C) y 0,88 (D) en el primer cuestionario. En el segundo fueron 1,71, 0,25, 0,75 y 0,35, respectivamente. La comparación de medias realizada mediante el test de ANOVA pone de manifiesto diferencias significativas. Al comparar los grupos entre sí encontramos: 1. A frente a B: diferencia significativa en ambos cuestionarios (p 0,006 y 0,011). 2. A frente a C: no significación en el primer cuestionario (0,051) y sí en el segundo (0,012). 3. A frente a D: diferencia en ambos cuestionarios (0,001 y 0,010). El uso de benzodiacepinas añadidas a la anestesia local (B frente a D) no mostró diferencias estadísticas en ambos cuestionarios (0,825 y 0,685). Conclusión: consideramos que el uso de benzodiacepinas no está justificado como método único de control del dolor para la realización de la biopsia prostática(AU)
Introduction: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. Materials and methods: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. Results: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant di fferences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant di fferences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant di fference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant di fferences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). Conclusion: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted(AU)
Humans , Male , Biopsy/methods , Biopsy , Prostate-Specific Antigen/analysis , Lidocaine/therapeutic use , Analysis of Variance , Prospective Studies , Anesthesia , Clorazepate Dipotassium/therapeutic use , Anesthesia, Local , Surveys and Questionnaires , Benzodiazepines/therapeutic use , Pain/therapy
OBJECTIVE: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. METHODS: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. RESULTS: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60 degrees flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. CONCLUSIONS: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery.
Laparoscopy , Nephrectomy/adverse effects , Nephrectomy/methods , Rhabdomyolysis/etiology , Humans , Male
Hydronephrosis/congenital , Pregnancy Complications , Ureteral Diseases/congenital , Adult , Female , Humans , Hydronephrosis/diagnosis , Hydronephrosis/therapy , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Ureteral Diseases/diagnosis , Ureteral Diseases/therapy
Cada vez son más frecuentes en nuestras consultas los pacientes diagnosticados de HBP en los que al indicar la intervención quirúrgica, se plantean limitaciones por la toma de medicación concomitante, edad, morbilidad asociada o condiciones psicosociales. La RTU de próstata, aun siendo el patrón quirúrgico de referencia, en este grupo de pacientes ancianos y de alto riesgo, no está exenta de complicaciones como la posibilidad de reabsorción, sangrado e incluso transfusión en un porcentaje de casos. La fotovaporización prostática mediante láser puede ser una alternativa válida en este subgrupo de pacientes. Revisamos nuestra experiencia en este procedimiento, así como lo publicado al respecto y describimos recomendaciones técnicas que consideramos útiles para evitar en lo posible complicaciones durante la cirugía o en el postoperatorio inmediato (AU)
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period (AU)
Humans , Male , Lasers/therapeutic use , Laser Therapy/methods , Laser Therapy/trends , Morbidity , Urinary Retention/surgery , Urinary Retention , Cystoscopy/methods , Endoscopy/methods , Psychosocial Impact , Neovascularization, Physiologic/physiology , Angiogenesis Inhibitors/therapeutic use , Length of Stay/economics
No disponible
Humans , Female , Aged , Ureterolithiasis/etiology , Urinary Diversion/adverse effects , Urinary Diversion/methods
Objetivos: Nos planteamos en este caso clínico mostrar el manejo de la rabdomiolisis secundaria a la cirugía laparoscópica y como el tratamiento médico puede ser suficiente para una correcta resolución del mismo. Métodos: La nefrectomía laparoscópica es una técnica de rutina, no exenta de morbilidad asociada. Presentamos un caso de rabdomiolisis que debutó como dolor glúteo e impotencia funcional, junto con alteraciones cutáneas, insuficiencia renal aguda y enzimas musculares elevadas. Resultados: En nuestro caso el paciente evolucionó satisfactoriamente con tratamiento médico. Hacemos una revisión de la literatura publicada, donde se identifican múltiples factores de riesgo, tales como el IMC (índice de masa corporal), tiempo quirúrgico, la posición durante el acto quirúrgico en decúbito lateral con flexión 40-60°. La prevención es el factor más importante para evitar la insuficiencia renal aguda por mioglobina. Conclusiones: La prevención, la detección precoz y la instauración inmediata de medidas terapeúticas son fundamentales para la buena resolución del cuadro de rabdomiolisis tras cirugía (AU)
Objective: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. Methods: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. Results: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60° flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. Conclusions: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery (AU)
Humans , Male , Rhabdomyolysis/etiology , Rhabdomyolysis/diagnosis , Nephrectomy/adverse effects , Nephrectomy/methods , Laparoscopy/adverse effects
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.
Laser Therapy/methods , Prostatic Hyperplasia/surgery , Equipment Design , Humans , Laser Therapy/instrumentation , Male , Risk Factors
UNLABELLED: Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. OBJECTIVE: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU. MATERIALS AND METHODS: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. RESULTS: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%. CONCLUSION: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.
Magnetic Resonance Imaging , Urologic Diseases/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Urography/methods
La urografía convencional (UIV) es una exploración fundamental en la valoración del aparato urinario no exenta de morbilidad, como reacciones adversas al contraste (vasovagales y anafilácticas), neurotoxicidad, nefrotoxicidad, así como la irradiación ionizante a la que somete al paciente. Por este motivo se desarrollan técnicas de imagen alternativas como la urografía por resonancia magnética (RM) o urorresonancia. Objetivos: Presentamos un estudio que valora la precisión diagnóstica, especificidad y sensibilidad de la urorresonancia y de la UIV como exploración morfológica y funcional del aparato urinario; así como de la calidad de las imágenes urográficas obtenidas con la RM frente a la UIV. Material y métodos: 150 pacientes han sido sometidos a un estudio de RM, en 63 de ellos se realizó también estudio urográfico convencional, con apreciación de señales de alta intensidad en T2 correspondientes al fluido abdominal y retroperitoneal, empleando previamente furosemida a bajas dosis, y en un estudio final, administrando gadolinio a razón de 0,1 mg./Kg. La prueba fue indicada en pacientes con antecedentes de reacciones adversas al contraste yodado, fracaso renal agudo o crónico, anulación funcional renal, pacientes embarazadas y en edad infantil así como cuando la UIV no fue diagnóstica. Se estudió la capacidad de ambas pruebas para el diagnóstico de obstrucción urinaria y de la etiología de esta. También se evalúo la calidad de las imágenes que ofrece el estudio urográfico con RM. Resultados: Se obtuvieron imágenes de alta resolución con la RM de toda la vía urinaria superior, especialmente de pelvis renal, no artefactadas por la peristalsis o la interposición del fluido intestinal. En el 83,3% de los casos la exploración reveló patología urológica. La precisión diagnóstica de la causa de afectación del aparato urinario fue de un 83,3%, con una sensibilidad del 89,6%, una especificidad del 69,2%, valor predictivo positivo del 86,6% y valor predictivo negativo del 75%. Conclusión: La urografía por RM es una técnica con una elevada sensibilidad para el estudio del aparato urinario, que puede ser empleada como alternativa a la urografía convencional especialmente en los casos de contraindicación de la radiación ionizante, alergia al contraste, así como en pacientes con fracaso renal, pero que ofrece un estudio morfológico y funcional más amplio, con elevada calidad de imágenes, pudiendo desplazar a los estudios convencionales en un plazo corto o medio de tiempo
Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. Objective: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract; and a quality study of the urographic images obtained with MR versus IVU. Materials and methods: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. Results: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%, a positive predictive value of 86.6% and a negative predictive value of 75%. Conclusion: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term
Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Humans , Urography , Magnetic Resonance Spectroscopy/methods , Urologic Diseases/diagnosis , Furosemide/therapeutic use
Objetivos: La prostatectomía radical retropúbica continúa siendo el tratamiento de elección para el cáncer de próstata órganoconfinado. Realizamos un estudio retrospectivo en el que valoramos las complicaciones de esta cirugía y su evolución en el tiempo así como la cantidad del tratamiento conservador, especialmente la rehabilitación perineal precoz, en la recuperación de la continencia tras esta intervención. Material y métodos: Durante el período comprendido entre diciembre de 1998 a enero del 2005 hemos intervenido en nuestro servicio a 168 pacientes afectos de adenocarcinoma prostático confinado clínicamente a la glándula mediante prostatectomía radical retropúbica. Retiramos la sonda vesical el decimocuarto día del postoperatorio. A los pacientes que presentarion incontinencia urinaria (IU) de esfuerzo se les instruyó para la realización de ejercicios para fortalicer el suelo pélvico. Realizamos un seguimiento clínico el primer, tercer y sexto mes tras la cirugía, y posteriormente de forma semestral. Resultados: De los 168 pacientes intervenidos, el 15% requirió hemotransfusión en el postoperatorio inmediato. Otras complicaciones precoces, de mucha menos incidencia, fueron la perforación intestinal, la infección de la herida quirurgica y la foramción de hematoma en el lecho quirúrgico. Entre las complicaciones tardías más frecuentes registramos la disfunción eréctil, que se presentó en 164 pacientes (98%), alteraciones miccionales en 32 pacientes (19%) y alteraciones intestinales en aproximadamente el 11%. Entre las alteraciones miccionales encontradas, la más frecuente fue la IU (64%) si bien la mayoría de ellas eran de carácter leve (34%) y todas mejoraron durante los primeros seis meses posteriores a la cirugía. Conclusiones: La IU es el principal condicionante de la calidad de vida de los pacientes que son sometidos a prostatectomía radical. Si bien el porcentaje de pacientes que la presenta es alto, la mayoría son de grado leve o moderado y pueden mejorar ostensiblemente con los ejercicios de fortalecimiento del suelo pélvico, constituyéndose así como un arma fundamental en el menejo de estos pacientes, acompañada o no del uso de absorbentes, de la terapia farmacológica o del empleo de colectores peneanos
Objectives: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complication of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary incontinence. Materials and methods: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and there after every six monoths. Results. Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion inthe immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. Conclusions. Radical prostatectomy continues to the most effective treatment for the non spared prostate cancer, in spite, of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors
Male , Adult , Aged , Middle Aged , Humans , Prostatectomy/adverse effects , Prostatic Hyperplasia/surgery , Prostatic Neoplasms/surgery , Urinary Incontinence/epidemiology , Postoperative Complications/epidemiology , Surgical Mesh , Retrospective Studies , Urinary Tract Infections/epidemiology , Erectile Dysfunction/epidemiology
INTRODUCTION AND OBJECTIVES: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. PATIENTS AND METHOD: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. RESULTS: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. CONCLUSIONS: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated.
Cysts/diagnosis , Cysts/therapy , Genital Diseases, Male/diagnosis , Genital Diseases, Male/therapy , Seminal Vesicles , Aged , Aged, 80 and over , Humans , Male , Middle Aged
Introducción y objetivo: La displasia quística de la vesícula seminal representa una rara anomalía congénita urológica cuyo tratamiento de elección es controvertido. Presentamos nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente entidad. Pacientes y método: Durante los últimos 12 años hemos atendido a 8 pacientes afectos de esta patología. En 3 de ellos, asintomáticos, el diagnóstico fue incidental, mientras que los 5 restantes consultaron por síntomas del tracto urinario inferior. En 3 pacientes se halló desembocadura ectópica de un uréter remanente en la vesícula patológica, 2 de ellos con importante ectasia renoureteral. Los otros 5 pacientes presentaron agenesia renal. Resultados: En los pacientes asintomáticos adoptamos una actitud expectante, optando por la cirugía en los otros 5. Realizamos cirugía exerética en los 2 casos que presentaban ureterohidronefrosis, mientras que en los otros 3 realizamos incisión endoscópica de la vesícula seminal, obteniendo excelentes resultados en todos ellos, sin evidenciarse aparición de pseudodivertículo sintomático. Conclusiones: La incisión transuretral endoscópica del quiste de la vesícula seminal es un procedimiento mínimamente invasivo y con escasa morbilidad, habiendo constatado la retracción prácticamente completa del quiste en todos nuestros casos, por lo que la consideramos de elección para el tratamiento de los pacientes afectos de dicha entidad, reservando la cirugía abierta para los casos en los que fracase la técnica por aparición de un pseudodivertículo sintomático y en los pacientes que presenten asociada ectasia del remanente renoureteral
Introduction and objectives: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. Patients and method: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. Results: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. Conclusions: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated
Male , Adult , Adolescent , Middle Aged , Humans , Seminal Vesicles/pathology , Cysts/pathology , Kidney/abnormalities , Ultrasonography
OBJECTIVES: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence. MATERIALS AND METHODS: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months. RESULTS: Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. CONCLUSIONS: Radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors.
Adenocarcinoma/surgery , Exercise Therapy , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Adult , Aged , Humans , Male , Middle Aged
