Prevalence and management of urinary incontinece after pelvic organ prolapse surgery (sacrocolpopexy). A literature review.

INTRODUCTION: Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment. AIM: To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature. MATERIALS AND METHOD: Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023. RESULTS: Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2). CONCLUSION: Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.

Carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en carcinoma de células renales: nuestra experiencia y revisión de la literatura / Peritoneal carcinomatosis after partial nephrectomy for renal cell carcinoma: Our experience and literature review

Objetivo: La carcinomatosis peritoneal asociada al carcinoma de células renales es una entidad infrecuente, normalmente asociada a grandes masas renales, siendo muy rara su presentación tras la cirugía de tumores renales localizados. Nuestro objetivo es revisar la literatura y analizar los factores implicados en el desarrollo de carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en tumores localizados.Material y métodos: Presentamos nuestra experiencia con 2 casos de carcinomatosis peritoneal tras cirugía parcial laparoscópica. Realizamos revisión de la literatura y analizamos los factores asociados al desarrollo de carcinomatosis peritoneal tras cirugía parcial laparoscópica en carcinoma de células renales.Resultados: Entre 2005-2018 en nuestro servicio fueron sometidos a nefrectomía parcial laparoscópica 225 pacientes por neoplasia renal localizada. Dos pacientes desarrollaron carcinomatosis peritoneal en el seguimiento, uno al año y medio de la cirugía y un segundo caso a los 7 años. Pocos casos de carcinomatosis peritoneal tras cirugías de neoplasia renal han sido descritos en la literatura, estando más frecuentemente asociados a grandes masas renales, con múltiples metástasis al diagnóstico, siendo el pronóstico infausto. Entre los factores implicados en su desarrollo pueden estar la diseminación de células tumorales durante la cirugía, la extensión tumoral directa o la metástasis por vía hematógena.Conclusiones: La carcinomatosis peritoneal tras nefrectomía parcial laparoscópica constituye un evento muy raro, pero que debe ser tenido en cuenta y, dado que es el único factor en el que podemos influir, extremar al máximo las precauciones durante el acto quirúrgico, siguiendo los principios oncológicos. (AU)

Objective: Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors.Material and methods: We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma.Results: Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition.Conclusions: Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles. (AU)

Peritoneal carcinomatosis after partial nephrectomy for renal cell carcinoma: Our experience and literature review.

OBJECTIVE: Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors. MATERIAL AND METHODS: We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma. RESULTS: Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition. CONCLUSIONS: Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles.

Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy. / Efecto de la quimioterapia adyuvante en el carcinoma urotelial de vejiga localmente avanzado tratado con cistectomía.

INTRODUCTION: Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE: To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS: Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5). Comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS: 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p=.25) or pT4pN0 (p=.29) patients, but it was significant in pT3-4pN+ (p=.001). Multivariate analysis showed pathological stage (p=.0001) and treatment with ADJ (p=.007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p=.007). CONCLUSIONS: pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage analysis.

Comparison of classical transrectal prostate biopsy versus cognitive registration in rebiopsy. / Comparación del rendimiento entre biopsia transrectal clásica y biopsia «cognitiva¼ ecodirigida en la rebiopsia de la próstata.

INTRODUCTION: The aim of this study is to compare performance of two biopsy approaches in patients with at least one previous negative prostate biopsy (PB): classical transrectal biopsy (ClTB) versus cognitive registration biopsy (COG-TB). MATERIAL AND METHODS: A retrospective study of 205 patients with at least one negative PB. 144 (70.2%) patients underwent a prior mpMRI and 61 (29.8%) patients did not. Nodule classification was carried out according PI-RADS version 2. Peripheral zone (PZ) grouped pZa, pZpl and pZpm areas, transition zone (TZ) Tza, Tzp and Cz areas, and anterior zone (AZ) AS areas. COG-TB was conducted in patients with previous mpMRI (144); while in the remaining 61 (29.8%) patients a ClTB of PZ and TZ was performed. Statistical analysis was performed using Chi square and T-student tests for qualitative and quantitative variables, respectively. Multivariate analysis was carried out in order to identify predictive variables of prostate cancer. RESULTS: Median patient age was 68 (IQR 62-72) years, median PSA was 8.3 (IQR 6.2-11.7) ng/ml and median previous biopsies was 1 (IQR 1-2). Digital rectal examinations (DRE) findings were normal in 169 (82.4%) patients and suspicious in 36 (17.6%) patients (cT2a-b in 34 patients and cT2c in 2). Median prostate volume was 48 (IQR 38-65) cc. Statistically significant differences in PSAD between both groups were found (P=.03). Transrectal ultrasound (TRUS) showed hypoechoic nodules in 8 (13.1%) ClTB patients and in 62 (43.1%) COG-TB patients (P=.0001). The median number of biopsy cylinders per set of prostate biopsies was 10 (IQR 10-10) in ClTB group and 11 (IQR 9-13) in COG-TB group (P=.75). Cancer was diagnosed in 74 (36.1%) patients: of them, 10 (16.4%) were ClTB patients and 64 (44.4%) COG-TB (P=.0001). Tumors classification was as follow: ISUP-1: 34 (45.9%), ISUP-2: 21 (28.4%), ISUP-3: 9 (12.2%), ISUP-4: 7 (9.5%) and ISUP-5: 3 (4.1%). No significant statistical differences were found (P=.89). The median number of biopsy cylinders impaired per set of prostate biopsies was 1 (IQR 1-5) in ClTB group and 2 (IQR 1-4) in COG-TB group (P=.93). Regarding independent predictive variables for prostate cancer the results were: age (OR=12.05; P=.049), suspicious DRE (OR=2.64; P=.04), hypoechoic nodule (OR=2.20; P=.03) and mpMRI +COG-TB sequence (OR=3.49; P=.003). CONCLUSIONS: In patients with at least one negative PB, mpMRI +COG-TB sequence improves 3.5 (OR=3.49) times the diagnosis prostate vs. ClTB.

Influence of venous tumour extension on local and remote recurrence of stage pT3a pN0 cM0 kidney tumours. / Influencia de la extensión tumoral venosa en la recidiva local y a distancia de los tumores renales en un estadio pT3a pN0 cM0.

INTRODUCTION AND OBJECTIVE: One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. MATERIALS AND METHODS: A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990-2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. RESULTS: The results of 153 patients were studied. The median follow-up was 82 (IQR 36-117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9-144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=.0001), and microvascular invasion (p=.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. CONCLUSIONS: In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Effectiveness of the «cognitive¼ biopsy in the diagnosis of prostate cancer in patients with a previous negative biopsy. / Efectividad de la biopsia «cognitiva¼ en el diagnóstico del cáncer de próstata en los pacientes con biopsia previa negativa.

INTRODUCTION: Evaluation of the effectiveness of cognitive biopsy (CB) in patients with clinical suspicion of prostate cancer (PC), and at least one negative biopsy (TRB). MATERIAL AND METHOD: Retrospective study of 144 patients with at least one previous TRB and magnetic resonance imaging (MRI). The MRI nodules were classified based on PI-RADS v2 grouping pZa, pZpl and pZpm as the peripheral zone(PZ), Tza, Tzp and CZ as the transitional zone (TZ), and the AS zones as the anterior zone (AZ). A biopsy was indicated for nodules ≥PI-RADS 3. Uni and multivariate analysis was undertaken (logistic regression) to identify variables relating to a PI-RADS 3 tumour on biopsy. RESULTS: The median age was 67 (IQR: 62-72) years, the median PSA was 8.2 (IQR: 6.2-12) ng/ml. A nodule was identified on MRI in the PZ in 97 (67.4%) cases, in the TZ in 29 (20.1%), and in the AZ in 41 (28.5%). PC was diagnosed on biopsy in 64 (44%) patients. The cancer rate in the PI-RADS 3 lesions was 17.5% (7/40), in the PI-RADS 4 47.3% (35/73), and in the PI-RADS 5 lesions it was 73.3% (22/29) (p=.0001). Multivariable analysis with variables that could influence the biopsy result in patients with PI-RADS 3: None (age, PSA, number of previous biopsies, rectal examination, PSAD, prostate volume or number of extracted cylinders) behaved as an independent tumour predictor. CONCLUSIONS: The diagnostic performance of CB in patients with at least one previous negative biopsy was 44%, increasing according to the PI-RADS grade, and low in PI-RADS 3. No clinical variable predictive of cancer was found in patients with PI-RADS 3.

Traumatic rupture of horseshoe kidney.

We present the case of a 25-year-old male who came to the emergency room for pain and abdominal distension following trauma to the mesogastrium. A CT scan was performed, revealing a voluminous retroperitoneal hematoma with laceration of both inferior renal poles with regard to rupture of the isthmus of a horseshoe kidney. The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. Following 1 year of monitoring, the patient has maintained normal renal function. Renal affection in blunt abdominal trauma is frequent, occurring in 7% of previously pathological kidneys. The traumatic rupture of horseshoe kidney is facilitated by its particular anatomical characteristics, constituting an infrequent entity, knowledge of which is necessary to achieve conservative management that renders it possible to preserve renal function.

Ampliación vesical con uso de aparato digestivo. Indicaciones, seguimiento y complicaciones / Bladder augmentation using the gastrointestinal tract. Indication, follow up and complications

La ampliación vesical utilizando el tracto gastrointestinal tiene por objetivo crear un reservorio de baja presión y alta capacidad, permitiendo una continencia y vaciado adecuados, preservando el tracto urinario superior.OBJETIVO: Analizar las indicaciones, complicaciones y resultados de nuestra serie de enterocistoplastias de aumento.MÉTODO: Revisamos retrospectivamente los pacientes sometidos a enterocistoplastia de aumento en nuestro servicio entre los años 1997 y 2010 ambos inclusive. Las indicaciones fueron: Cistitis intersticial, vejiga neurógena y retracción vesical inflamatoria. En todos los casos se realizó cistografía, uretrocistoscopia, estudio urodinámico y diario miccional, así como los estudios propios de cada patología. Mediante laparotomía media y abordaje extraperitoneal se realiza la liberación vesical con apertura bivalva hasta los orificios ureterales. La ampliación vesical se realiza con un segmento de 15-20 cm de íleon detubulizado a 20 cm de la válvula ileocecal; en los casos de insuficiencia renal se añadió una cuña de 7 cm de cuerpo gástrico. La sonda vesical se retiró tras cistografía a los 15 días. El seguimiento se realizó mediante ecografía con residuo postmiccional, analítica sanguínea, urocultivo y diario miccional.Realizamos un estudio descriptivo de las características demográficas, complicaciones postoperatorias según la clasificación de Clavien y a largo plazo(AU)

RESULTADOS: Incluimos 24 pacientes, 19 mujeres y 5 varones con una edad media de 48,5 años y una mediana de 47 (21-77). El seguimiento medio fue de 7,5 años con una mediana de 8. Las indicaciones fueron: 7 cistitis intersticiales, 9 retracciones vesicales y 8 vejigas neurógenas. No hubo complicaciones intraoperatorias. Las complicaciones postoperatorias fueron 3 Clavien I, 2 tipo II, 2 IIIa y 1 IIIb. A largo plazo 3 pacientes presentan incontinencia urinaria, 2 acidosis metabólica leve, 5 precisan autocateterismos, 6 litiasis vesicales, 2 infecciones urinarias febriles y 1 estenosis de la boca anastomótica. En tres casos se realizó ileogastrocistoplastia sin deterioro hidroelectrolitico ni de la función renal.CONCLUSIONES En pacientes seleccionados la enterocistoplastia de aumento constituye una opción terapéutica eficaz con escasa morbilidad y complicaciones en el tratamiento de la disfunción del tracto urinario inferior(AU)

The purpose of bladder augmentation using the gastrointestinal tract is to create a low-pressure and high-capacity reservoir, permitting suitable continence and voiding, preserving the upper urinary tract.OBJECTIVE: To analyze the indications, complications and results of our series of augmentation enterocystoplasties.METHOD: We retrospectively reviewed patients undergoing augmentation enterocystoplasty in our department between 1997 and 2010, both included. The indications were: Interstitial cystitis, neurogenic bladder and inflammatory bladder retraction. In all cases a cystography, urethrocystoscopy, urodynamic study and voiding diary were performed, as well as the specific studies of each condition. Bladder release is performed by means of medial laparotomy and an extraperitoneal approach with bivalve opening to the urethral orifices. The bladder augmentation is performed with a 15-20 cm segment of detubularized ileum obtained at 20 cm from the ileocecal valve; in cases of kidney failure, a 7-cm gastric body wedge is added. The bladder catheter was removed following cystogram after 15 days.Monitoring was performed by means of ultrasound with postvoid residual, blood analyses, urine culture and voiding diary. We performed a descriptive study of the demographic characteristics, postoperative complications according to the Clavien classification and in the long term(AU)

RESULTS: We included 24 patients, 19 women and 5 men with a mean age of 48.5 years and a median of 47 (21-77). Mean follow up was 7.5 years with a median of 8 (1-11). The indications were: 7 interstitial cystitis, 8 bladder retraction and 7 neurogenic bladder. There were no intraoperative complications. The postoperative complications were 3 Clavien I, 2 type II, 2 IIIA and 1 IIIB.In the long term, 3 patients presented urinary incontinence, 2 mild metabolic acidosis, 5 required self-catheterization, 6 bladder stones, 2 febrile urinary tract infections and 1 stricture of the anastomotic mouth. In three cases, an ileogastrocystoplasty was performed without hydroelectrolytic impairment or impairment of kidney function.CONCLUSIONS: In selected patients, augmentation enterocystoplasty constitutes an efficacious therapeutic option in the treatment of lower urinary tract dysfunction with scant morbidity and few complications(AU)

[Assessment of effectiveness and security of bladder neck cerclage after transvesical prostatectomy]. / Evaluación de la eficacia y seguridad del cerclaje cervical temporal tras una adenomectomía prostática.

INTRODUCTION: The Bladder neck cerclage diminishes the risk of bleeding after transvesical prostatectomy, but it increases the risk of suffering postoperative bladder neck sclerosis. Our objective is to value the effectiveness and therapeutic security of the temporary bladder neck cerclage after transvesical prostatectomy. MATERIAL AND METHODS: It was carried out a prospective and longitudinal study in a cohort of 25 age patients mean age 68,5 years (standard deviation, 2,6 years), subjected to transvesical prostatectomy (Freyer) with bladder neck cerclage using polipropilene number 1 suture, that was retired at the 24 hours of the surgery. To value the hemostatic utility of bladder neck cerclage, it was measured the hematocrit and hemoglobin concentration at the 24 hours of the intervention. To evaluate the appearance of obstructive sequels, the maximum urinary flow was measured three months after the surgery. RESULTS: It was observed a mean hematocrit at the 24 hours of surgery of 7,3%, and a mean decrease of the hemoglobin at the 24 hours of the surgery of 2,7 gr/dl. In any cases the postoperative hemoglobin concentration was inferior to 8 mg/dl, therefore, it was not necessary transfusion. The uroflowmetry carried out at 3 months of surgery showed that 24 of the 25 intervened patients presented a maximum flow superior to 15 ml/sg. CONCLUSIONS: The temporary bladder neck cerclage is a good hemostatic technique. The precocious cercalge retreat avoids the late sequels (bladder neck sclerosos), that originates the permanent cerclage.

El transporte de heridos por vía aérea durante la campaña del norte de África / Air evacuation of casualties during the North African campaign 1921-1927

La Gran Guerra cambió por completo los conceptos de asistencia médico-quirúrgica de urgencia en la campaña del norte de África, aconsejando que se practicara lo más cercana posible al frente. Se idearon formaciones quirúrgicas móviles que acompañaban a las tropas como el hospital quirúrgico de montaña inspirado en la ambulancia quirúrgica automóvil de Marcille, el auto Chir de Prousts y Gosset o el hospital quirúrgico móvil de Plisson usados por belgas y franceses en la I Guerra Mundial. La idea hasta entonces en nuestros territorios del norte de África era instalar hospitales fijos en las grandes ciudades, hasta donde los heridos debían ser transportados en lentos convoyes que circulaban por malas carreteras y bajo el acoso del enemigo. Esto hacía que los heridos llegasen en muy malas condiciones y que por tanto los resultados fueran funestos. Esta modificación de la doctrina sanitaria fue vital en el comienzo del uso de los aviones sanitarios para el transporte de los heridos graves a los hospitales de retaguardia con urgencia y rapidez. En este trabajo se realiza una descripción de la ubicación de los primeros aeródromos de nuestras posesiones norteafricanas, un estudio de los primeros aparatos, personal encargado de su pilotaje y cuidados así como un relato en cifras de las primeras aeroevacuaciones (AU)

The Great War completely changed the concepts of emergency medical care in the North African campaign, with the recommendation to provide the medical care as near as posible to the front line. Mobile surgical formations were designed which followed the units, as the mountain surgical hospital, inspired in the Marcille´s automobile surgical ambulance, Proust and Gosset´s or Plisson´s mobile surgical hospital used by Belgians and French in the World War I. Until then the concept in our North African territories was to establish fixed hospitals in the big cities, to which the wounded had to be transported in slow convoys that travelled on bad roads and under the harassment of the enemy. This usually caused the wounded to arrive in seriuly deteriorated conditions and therefore the outcome was often disastrous. This modification of the medical support doctrine was vital in the beginning of the use of the medical planes for the evacuation of the severly wounded to the rear hospitals with urgency and rapidity. In this article a description of the location of the first aerodromes in our North African possessions is made, as well as a study of the first aircrafts, flying and maintenance personnel and an account in numbers of the first air evacuations (AU)

Evaluación de la eficacia y seguridad del cerclaje cervical temporal tras una adenomectomía prostática / assessment of effectiveness and security of bladder neck cerclage after transvesical prostatectomy

Introducción: El cerclaje del cuello vesical disminuye el riesgo de sangrado tras adenomectomía prostática, pero aumenta el riesgo de padecer esclerosis cervical postoperatoria. Nuestro objetivo es valorar la eficacia y seguridad terapéutica del cerclaje temporal del cuello vesical tras adenomectomía prostática. Material y métodos: Se realizó un estudio longitudinal perspectivo en una cohorte de 25 pacientes de edad media 68,5 años (desviación típica, 2,6 años), sometidos adenomectomía prostática transvesical tipo Freyer con cerclaje cervical temporal utilizando polipropileno del número 1 que se retiró a las 24 horas de la cirugía. Para valorar la utilidad hemostática del cerclaje se midió el descenso del hematocrito y la concentración de hemoglobina a las 24 horas de la intervención. Para evaluar la aparición de secuelas obstructivas se midió el flujo miccional máximo a los tres meses de la cirugía. Resultados: Se observó una disminución media del valor hematocrito a las 24 horas de la cirugía del 7,3%, y una disminución media de la hemoglobina a las 24 horas de la cirugía de 2,7 gr./dl. En ninguno de los casos la concentración de hemoglobina postoperatoria fue inferior a 8 mg/dl, por lo que no se precisó transfusión. Los resultados obtenidos en la medición de la flujometría realizada a los 3 meses de esta mostró que 24 de los 25 pacientes intervenidos presentaron a los 3 meses un flujo máximo superior a 15 ml/sg. Conclusiones: El cerclaje vesical temporal es una buena técnica hemostática. La retirada precoz del cerclaje evita las secuelas tardías (esclerosis de cuello vesical) que origina el cerclaje permanente

Introduction: The Bladder neck cerclage diminishes the risk of bledding after transvesical prostatectomy, but it increases the risk of suffering postoperative bladder neck sclerosis. Our objective is to value the effectiveness and therapeutic security of the temporary bladder neck cerclage after transvesical prostaectomy. Material and methods: It was carried out a prospective and longitudinal study in a cohort of 25 age patients mean age 68,5 years (standard deviation, 2,6 years), subjected to transvesical prostatectomy (Freyer) with bladder neck cerclage using polipropilene number 1 suture, that was retired at the 24 hours of the surgery. To value the hemostatic utility of bladder neck cerclage, it was measured the hematocrit and hemoglobin concetration at the 24 hours of the intervention. To evaluate the appearance of obstructive sequels, the maximun urinary flow was measured three months after the surgery. Results: It was observed a mean hematocrit at the 24 hours of surgery of 7,3%, and a mean decrease of the hemoglobin at the 24 hours of the surgery of 2,7 gr/ dl. In any cases the postoperative hemoglobin concentration was inferior to 8 mg/dl, therefore, it was not necessary transfusion. The uroflowmetry carried out at 3 months of surgery showed that 24 of the 25 intervened patients presented a maximum flow superior to 15 ml/sg. Conclusions: The temporary bladder neck cerclage is a good hemostatic technique. The precocious cercalge retreat avoids the late sequels (bladder neck sclerosos), that originates the permanent cerclage

Ginecomastia en varón joven por tumor de Leydig bilateral / No disponible

Se presenta el caso de un varón de 25 años de edad que presentó ginecomastia bilateral de dos meses de evolución. A la exploración clínica se observó la presencia de tumoración en testículo derecho. Se realiza orquiectomía, siendo el diagnóstico anatomopatológico de tumor de Leydig. Catorce meses después apareció otra masa en el testículo izquierdo, que tras su extirpación se comprobó que correspondía a otro tumor de Leydig. Se discute la incidencia, presentación clínica, diagnóstico y tratamiento de este tipo de neoplasia testicular. Se concluye que se trata de tumores raros (3% de los tumores testiculares) y cuya evolución es generalmente benigna, aunque no se puede descartar su malignización. La afectación bilateral ocurre en el 3% de estos tumores

No disponible

Estudio comparativo del daño renal producido tras la litotricia según la localización litiásica / A comparative study of the renal damage produced after the extracorporeal shock wave lithotripsy according to the lithiasis lication

Introducción: La litroticia por ondas de choque (LEOC) es fundamental en el tratamiento de las litiasis. Sin embargo, existen evidencias de que puede producir daño renal. El objetivo de nuestro estudio es determinar el grado de afectación de la función glomerular y tubular tras LEOC, y si influye la localización litiásica en el tipo de daño renal. Material y métodos. Se realizó un estudio longitudinal prospectivo en 14 pacientes con función renal normal sometidos a LEOC. Se determinó el nivel basal, y a las 24 horas, al 4º y al 10º día post LEOC, de microalbuminuria (MA) (que valora la función glomerular), y de N-acetil glucosamida (NAG) y la alanina aminopeptidasa (AAP) (que valoran la función tubular).Resultados: Los niveles de basales de MA, NAG y AAP no mostraron diferencias significativas en relación con la localización de los cálculos. Se observó un aumento significativo de los tres parámetros sólo a las 24 horas post LEOC. No se observaron diferencias significativas en la variación de los niveles de microalbuminuria, AAP y NAG con el tratamiento en relación a la localización de los cálculos. Conclusiones: Existe un daño glomerular y tubular tras LEO. Este daño es independiente de la localización pélvica ocalicial del cálculo. En pacientes con función renal normal previa, el daño renal se recupera al 4º día post LEOC (AU)

Introduction: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after LEOC, and the influence of the lithiasis location on the type of renal damage. Material and methods: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetil glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function). Results: The basal levels of of MA, NAG and AAP didn’t show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones. Conclusions: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4º day post ESWL (AU)

[Categorization of adrenergic alpha 1 receptors in detrusor of patients with obstructive BPH. Initial study on experimental animal model]. / Categorización de receptores alpha 1-adrenérgicos en el detrusor de pacientes con HBP obstructiva. Estudio inicial en modelo animal de experimentación.

INTRODUCTION: The action of alpha 1-adrenergic receptor antagonists in ameliorating irritation and obstruction in patients with bladder outlet obstruction (due to Benign Prostatic Hyperplasia-BPH) has been demonstrated. Although it is well known that alpha 1-a receptors are responsible for prostate smooth muscle relaxation, the mechanism by which irritative bladder symptoms are improved is unknown. Different alpha 1 receptor subtypes may be involved. The objective of this study is to investigate the changes in the alpha-adrenergic receptor populations in the obstructed detrusor, and to determine which subtype is proportionally increased in this situation (bladder outlet obstruction). MATERIAL AND METHODS: This was an in vivo study in an experimental model: male NZ (New Zealand) rabbits. The bladder neck of one group of rabbits was obstructed surgically using the technique proposed by Levin et al. Subsequent to bladder catherization with a 8Fr catheter, the bladder neck was exposed by means of a low medial abdominal incision. The bladder neck was tied with a 2/0 silk thread below the ureteral orifices. The catheter was taken out at the end of the intervention. The rabbits were sacrificed after 4 weeks using intracardiac pentothal and cystectomy was performed. A control group that did not undergo bladder obstruction were also sacrificed at this time, for the comparative study. Part of the detrusor was used for a pathological study and the rest for a physio-pharmacological study in which the organ was placed in a bath of adrenoceptor agonists (phenylephrine and noradrenaline) and antagonists WB101, AH11101A and BMY7378 (antagonists of the alpha 1a, b, d, respectively). RESULTS: The findings of the pathological study show that the bladder wall was thicker in the rabbits that underwent bladder obstruction. The physio-pharmacological studies demonstrate that the detrusor response to the selective alpha-1 adrenergic agonist was greater in the rabbits that underwent bladder obstruction, however detrusor contractility was decreased (KPSS). With bladder obstruction the alpha 1d receptors were increased. DISCUSSION AND CONCLUSIONS: Receptor-binding studies (Malloy et al) aim to differentiate the alpha-adrenoreceptor populations. These studies identify and quantitate the different receptor subtypes in tissue without taking into account their activity. The isometric and physio-pharmacological tests evaluate active receptors, i.e. those that respond to agonist and antagonist stimuli. This enables detrusor activity to be evaluated accurately. The results obtained in this investigational study support the hypothesis that there is a high statistically significant increase in the alpha 1 adrenergic receptors in the obstructed detrusor. Furthermore, in agreement with previous molecular studies, during prostate obstruction alpha 1d is the predominate sub-population in the bladder. These findings may have patho-physiological, clinical and pharmacological implications. If this hypothesis which has been demonstrated in an experimental model, is also demonstrated in studies in humans, pharmacological development should not only be focussed on selective alpha 1a receptor antagonists (prostate) but also on those of alpha 1d, for relieving symptoms in patients with bladder outlet obstruction (BPH and prostatism).

Categorización de receptores alfa1-adrenérgicos en el detrusor de pacientes con hbp obstructiva.Estudio inicial en modelo animal de experimentación / Alfa1-Adrenergic receptors categorisation in the detrusor of patients with obstructive bph. Early study in experimental models

INTRODUCCIÓN: Los antagonistas de los receptores adrenérgicos alfa1 han demostrado su acción en pacientes con obstrucción al flujo vesical (Hiperplasia Benigna de Próstata-HBP) al mejorar los síntomas obstructivos e irritativos. Si bien es conocido que los receptores alfa1a son los responsables de la relajación del músculo liso de la próstata, es desconocido el mecanismo por el cual se mejoran los síntomas irritativos de responsabilidad vesical. Diferentes subtipos de receptores alfa1 podrían estar implicados. El objetivo de esta investigación es indagar en los cambios poblacionales de receptores -adrenérgicos en el detrusor obstruido, y determinar que subtipo es el que proporcionalmente aumenta en esta situación (obstrucción vesical al flujo miccional). MATERIAL Y MÉTODOS: El estudio se realiza in vivo en un modelo animal de experimentación: conejos machos NZ (Nueva Zelanda). Un grupo de ellos es obstruido quirúrgicamente, a nivel del cuello vesical, mediante la técnica propuesta por Levin et al.1,2. Previa cateterización vesical con sonda 8Fr, y a través de una incisión media abdominal baja se expone el cuello vesical, que será ligado con una seda de 2/0, por debajo de los orificios ureterales, retirando la sonda al final de esta intervención. Después de 4 semanas se sacrifica el conejo con pentotal intracardiaco y se realiza cistectomía. El grupo control son otros conejos no sometidos a obstrucción vesical que se sacrifican también en este momento para estudio comparativo. Parte del detrusor es sometido a estudio anatomo-patológico y el resto a un estudio fisio-farmacológico en baños de órgano mediante agonistas (phenilefrina y noradrenalina) y antagonistas de adrenoceptores: WB4101, AH11101A y BMY7378, antagonistas respectivos de los receptores alfa1a,b,d. RESULTADOS: Los hallazgos anatomo-patológicos demuestran mayor grosor de la pared de la vejiga en los casos de obstrucción vesical. Los estudios fisio-farmacológicos ponen de manifiesto que la respuesta del detrusor al agonista selectivo alfa1-adrenérgico es mayor en los conejos sometidos a obstrucción vesical, sin embargo la contractilidad del detrusor está disminuida (KPSS). En condiciones de obstrucción son los receptores alfa1d los que se ven aumentados. DISCUSIÓN Y CONCLUSIONES: Los estudios que pretenden diferenciar las distintas poblaciones de alfa-adrenoceptores son estudios de binding (Malloy et al.)3 que localizan y cuantifican los distintos subtipos de receptores presentes en el tejido sin tener en cuenta su actividad. Los ensayos isométricos y fisiofarmacológicos evalúan receptores activos, es decir, que responden a estímulos agonistas y antagonistas, lo que permite valorar con exactitud la actividad del detrusor. Los resultados obtenidos en este estudio de investigación, apoyan la hipótesis del incremento de receptores adrenérgicos alfa1 en el detrusor obstruido con una p altamente significativa, y coincidiendo con trabajos moleculares previos4, durante la obstrucción prostática la subpoblación predominante en la vejiga es la alfa1d. Estos hallazgos pueden tener implicaciones fisiopatológicas, clínicas y farmacológicas. Si esta hipótesis, demostrada en experimentación animal, se consigue demostrar en la fase humana de la investigación, el desarrollo farmacológico deberá localizarse no sólo en fármacos antagonistas selectivos de receptores alfa1a (próstata), sino también de los 1d, con responsabilidad clínica vesical en situación de obstrucción vesical al flujo miccional (HBP y prostatismo) (AU)

[Acute and immediate urination syndrome after transurethral resection: a case of incrustating cystopathy]. / Síndrome miccional agudo e inmediato post-RTU: un caso de cistopatía incrustante.

The authors present a case of acute and prompt symptomatic irritative urinary cystitis after transurethral resection (TR) of bladder cancer. The clinical presentation, like a irritative syndrome, was with a positive urine cultive to Enterococci and Staphylococcus. The physical examination, under general anesthesia (EBA), eliminated the urethral injury or the meatus trauma, so the urethral stenosis. The bladder view, in scaring processing yet, was congestive, bledding and edematous; an extensive white calcification was covering all the mucose surface bladder. The presumptive diagnosis was incrusted cystophatie (cystitis) and a transurethral resection (TR), along total bladder mucosa, was made so the result of pathological examination was sure. Intravenous and oral antimicrobial agent (Amoxicillin-Clavunan), in different ways, was instaured like a treatment, to achieve a negative urinary cultive, to eradicate the bacterial agents. We made a revision of the most important aspects in the clinical presentation, laboratory diagnosis and therapy, in this cystophatie that is not frequent, where the ureolitic bacterial agents have the responsibility, main Corynebacterium urealiticum, and where the recent urologic surgery or instrumentation, is narrowly related with the development of this cystophatie.

Síndrome miccional agudo e inmediato post-RTU: un caso de cistopatíaincrustante / Acute and prompt urination sindrom after transurethral resection (TR): a case of incrustant cystophatie

Presentamos un caso de sintomatología miccional aguda e inmediata después de RTU de neoplasia vesical. El cuadro miccional, de carácter irritativo, cursó con cultivo de orina positivo a Enterococo y Staphylococo. La exploración vesical bajo anestesia (EBA) descartó la afección uretral (estenosis). Todavía sin cicatrizar, se observó una mucosa vesical edematosa, congestiva y sangrante, cubierta por una extensa calcificación blanquecina. Con la impresión diagnóstica de cistopatía incrustante se realizó RTU de toda la mucosa vesical afecta (legrado). La anatomía patológica confirmó el diagnóstico. Se instauró tratamiento antibiótico (Amoxi-Clavulánico), en diferentes pautas, hasta que el cultivo de orina se negativizó. Se realiza revisión de los aspectos clínicos, diagnósticos y terapéuticos de esta cistopatía, no muy frecuente, donde las bacterias ureolíticas son los microorganismos responsables, fundamentalmente Corynebacterium ureolíticum, y donde la instrumentación endourológica está íntimamente relacionada con el desarrollo de la cistopatía (AU)

No disponible