ABSTRACT
Objetivo: Evaluar los efectos de la rizotomía sacral percutánea por radiofrecuencia en pacientes con lesión de la médula espinal sobre parámetros urodinámicos (capacidad cistométrica máxima [CCM] y presión del detrusor a capacidad cistométrica máxima [PdetCCM]). Material y Métodos: En este estudio prospectivo se evaluó a 8 pacientes con LME (4 hombres y 4 mujeres) con una media de edad de 31,3 años (de 22 a 41). El intervalo medio entre la lesión de la médula espinal y la rizotomía fue de 53,5 meses (entre 20 y 96). A todos los pacientes se les practicó un bloqueo anestésico bajo control fluoroscópico de la tercera raíz sacral de forma bilateral con bupivacaína 0,5%. Se eligió para rizotomía sacral percutánea por radiofrecuencia a los que respondieron con un aumento en la capacidad vesical. Se procedió a la evaluación urodinámica de todos los pacientes a los 6 y los 12 meses tras la realización del procedimiento. Se consignaron tanto la CCM como la PdetCCM. Resultados: Todos los pacientes mostraron una mejora significativa en la CCM a los 12 meses. El volumen vesical medio aumentó de los 100,2±57,1 a 282,9±133,4 ml (p < 0,05). La PdetCCM se redujo de 82,4±31,7 a 69,9±28,7 cm H2O (p = 0,2). Tres pacientes con disreflexia autonómica experimentaron un alivio total de los síntomas tras el procedimiento. A los 12 meses se observó una reaparición de la hiperactividad del detrusor en todos los pacientes. Un paciente presentó abolición de las erecciones reflejas tras el procedimiento. No se observaron complicaciones de importancia en relación con la rizotomía. Conclusiones: La rizotomía sacral percutánea por radiofrecuencia es una técnica mínimamente invasiva, de baja morbilidad, que puede aumentar la CCM. Existe una tendencia hacia la reducción de la PdetCCM en pacientes con LME a los 12 meses, a pesar de que no se alcanza un nivel estadísticamente significativo (AU)
Introduction: To evaluate the effects of percutaneous radiofrequency sacral rhizotomy in spinal cord injured (SCI) patients on urodynamic parameters (maximum cystometric capacity MCC and detrusor pressure at maximum cystometric capacity - PdetMCC). Material and Methods: This prospective study assessed eight patients with SCI (four men and four women) with a mean age of 31.3 years (22 to 41). Mean interval period between spinal cord lesion and rhizotomy was 53.5 months (20 to 96). All patients underwent an anesthetic block of the 3rd sacral root bilaterally using 0.5% bupivacaine under fluoroscopic control. Those who responded with an increase on bladder capacity were selected to undergo the percutaneous radiofrequency sacral rhizotomy. All patients underwent urodynamic evaluation at 6 and 12months following the procedure. MCC and PdetMCC were recorded. Results: All patients presented a significant improvement on MCC after 12 months. The mean vesical volume increased from 100.2±57.1 to 282.9±133.4 ml (p<0.05). The PdetMCC reduced from 82.4±31.7 to 69.9±28.7 cmH2O (p = 0.2). Three patients with autonomic dysreflexia had complete relief of symptoms after the procedure. At 12 months, recurrence of detrusor hyperactivity was observed in all patients. One patient presented abolishment of reflex erections after the procedure. No major complications related to the rhizotomy were noted.C onclusions: Percutaneous radiofrequency sacral rhizotomy is a minimally invasive technique with low morbidity able to increase MCC. There is a trend towards the reduction of the PdetMCC in SCI patients at 12 months, although statistical significance was not reached (AU)
Subject(s)
Humans , Male , Female , Adult , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/surgery , Autonomic Dysreflexia/diagnosis , Autonomic Dysreflexia/pathology , Urinary Bladder, Neurogenic/diagnosis , Urinary Incontinence/diagnosis , Urinary Bladder, Neurogenic/complications , Rhizotomy/instrumentation , Rhizotomy/methods , Rhizotomy , Urodynamics , Catheter Ablation , Anesthetics, LocalABSTRACT
INTRODUCTION: To evaluate the effects of percutaneous radiofrequency sacral rhizotomy in spinal cord injured (SCI) patients on urodynamic parameters (maximum cystometric capacity - MCC and detrusor pressure at maximum cystometric capacity - PdetMCC). MATERIAL AND METHODS: This prospective study assessed eight patients with SCI (four men and four women) with a mean age of 31.3years (22 to 41). Mean interval period between spinal cord lesion and rhizotomy was 53.5 months (20 to 96). All patients underwent an anesthetic block of the 3rd sacral root bilaterally using 0.5% bupivacaine under fluoroscopic control. Those who responded with an increase on bladder capacity were selected to undergo the percutaneous radiofrequency sacral rhizotomy. All patients underwent urodynamic evaluation at 6 and 12 months following the procedure. MCC and P(det)MCC were recorded. RESULTS: All patients presented a significant improvement on MCC after 12 months. The mean vesical volume increased from 100.2±57.1 to 282.9±133.4ml (p<0.05). The P(det)MCC reduced from 82.4±31.7 to 69.9±28.7cmH(2)O (p=0.2). Three patients with autonomic dysreflexia had complete relief of symptoms after the procedure. At 12 months, recurrence of detrusor hyperactivity was observed in all patients. One patient presented abolishment of reflex erections after the procedure. No major complications related to the rhizotomy were noted. CONCLUSIONS: Percutaneous radiofrequency sacral rhizotomy is a minimally invasive technique with low morbidity able to increase MCC. There is a trend towards the reduction of the P(det)MCC in SCI patients at 12 months, although statistical significance was not reached.
Subject(s)
Catheter Ablation/methods , Rhizotomy/methods , Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/surgery , Urinary Bladder, Overactive/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Nerve Block , Organ Size , Prospective Studies , Treatment Outcome , Urinary Bladder/pathology , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/pathology , Urinary Bladder, Overactive/etiology , Urodynamics , Young AdultABSTRACT
A total of 84 patients with superficial transitional cell carcinoma underwent transurethral resection of bladder tumor. All patients had stage pTa or pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies. The patients were assigned to three treatment groups: I. Control group-transurethral resection (TUR-BT) discontinued within the study. II. Oral BCG group-TUR-BT plus BCG (Moreau). III. Intravesical BCG group-TUR-BT plus BCG. Of 9 patients in the control group, 8 (89%) experienced tumor recurrence during a mean follow-up of 20 months. Of the 33 patients in the oral BCG group, 13 patients (39.3%) had recurrence during a mean follow-up of 39 months. Of the 42 patients in the intravesical group, 8 patients (19%) had recurrence in a 30-month mean follow-up. The incidence of complications was higher in the intravesical (33.4%) than in the oral BCG group (24.2%). These results showed that intravesical BCG is a more effective immunotherapy; however, oral BCG can be utilized in patients who do not accept intravesical BCG administration.
Subject(s)
BCG Vaccine/therapeutic use , Carcinoma, Transitional Cell/therapy , Immunotherapy , Neoplasm Recurrence, Local/prevention & control , Urinary Bladder Neoplasms/therapy , Administration, Intravesical , Administration, Oral , Adult , Aged , Aged, 80 and over , Carcinoma in Situ/therapy , Carcinoma, Transitional Cell/surgery , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Prospective Studies , Urinary Bladder Neoplasms/surgeryABSTRACT
The effects of BCG in the treatment of superficial bladder cancer in man are known, but the mechanism is not quite well understood. Thirty-six hamsters received BCG through three routes: intravesical, intradermal and oral. Each group was composed of 12 animals; BCG was administered to 9 and only saline solution to 3 hamsters. BCG was given once a week for six weeks. The animals were sacrificed at 20, 30 and 65 days after the last administration of BCG. The anatomopathologic study revealed granulomatous reaction in the liver of 5 hamsters and in the spleen of 4 other animals of the intravesical group. In all groups that received BCG, hyperplasia of periarteriolar lymphoid tissue (T zone) of the spleen was observed. We support the view that BCG promotes a systemic reaction whatever the route of administration may be.
Subject(s)
BCG Vaccine/adverse effects , Administration, Intravesical , Administration, Oral , Animals , BCG Vaccine/administration & dosage , BCG Vaccine/immunology , Cricetinae , Female , Injections, Intradermal , Prospective Studies , Random AllocationABSTRACT
The results of transurethral ureteroscopic stone removal in 144 patients were reviewed. Patients were treated by two different techniques according to the dilation of the ureterovesical junction before the introduction of the ureteroscope. Group 1 was represented by 71 patients submitted to ureteral dilation and in group 2 there were 73 patients treated without ureteral dilation. There was only one failure in introducing the instrument without ureteral dilation. In patients submitted to transurethral ureteroscopy with previous ureteral dilation, the success of ureteroscopic stone removal was 91.6% and complications occurred in 6.9%, and, in the cases not submitted to ureteral dilation, the success rate was 99.4% and the complication rate 4.1%. The success rate achieved in removing upper third stones was 100.0% middle third 90.5% and lower third stones 95.6%. Of the 144 patients treated, 8 (5.5%) had ureteral injury, but only 1 (0.6%) needed open surgery. We do not believe that ureteral dilation prevents complications or improves the results of ureteroscopic lithotripsy.
Subject(s)
Endoscopy/methods , Ureteral Calculi/therapy , Adult , Dilatation , Female , Humans , Male , UreterABSTRACT
Vasography may cause stricture of the vas deferens. The probable causes of this obstruction are traumatic lesion at the puncture site and the radiological contrast material used. Because of this problem we performed an experimental study using Wistar rats, which were divided into four groups: Group A - Control, Group B - injection of a saline solution, Group C - hypaque injection, Group D - hypaque plus saline solution. According to the results obtained it was concluded that the needle puncture is not responsible for stricture of the vas deferens. Hypaque is responsible for 5% of strictures and the use of a saline solution to wash the vas did not show any benefit.
Subject(s)
Vas Deferens/diagnostic imaging , Animals , Constriction, Pathologic/etiology , Diatrizoate , Male , Punctures , Radiography , Rats , Rats, Inbred Strains , Sodium Chloride , Vas Deferens/injuriesABSTRACT
We report a case which demonstrates that to approach an ureteral gunshot lesion endourologically may be an alternative to surgical intervention. We believe that drainage of a damaged ureter should, in selected cases, constitute the first option. This procedure often is successful, but may not be feasible in all cases. We do not believe that simple catheter drainage should replace standard surgical procedures. However, it presents a less invasive treatment alternative which still adheres to conventional surgical principles if a proper patient selection is made.
