ABSTRACT
Las estenosis ureterointestinales representan un problema importante en los pacientes sometidos a una cistectomía radical y una derivación urinaria utilizando segmento intestinal, bien sea éste intestino delgado o grueso. Con la incorporación de la tecnología láser en la urología, se han abierto unas posibilidades terapéuticas para la sección de estas estenosis ureterointestinales. Se han empleado distintos tipos de láser para realizar la incisión que son el Nd:YAD, el KTP:YAG, el Ho: YAG, el Er:YAG y el Th:YAG. La experiencia es limitada con respecto a su uso y los resultados no conllevan orientaciones terapéuticas claras. La sección de las estenosis ureterointestinales mediante el láser tiene ventajas e inconvenientes, pero la aplicación de esta fuente de energía junto con distintas técnicas de sección endoscópica, como la técnica de endoureterotomía mediante invaginación endoluminal de F. Lovaco proporciona unos resultados satisfactorios a cortomedio plazo (AU)
Objectives: Ureteral-intestinal anastomosis represent an important problem in patients undergoing radical cystectomy with urinary diversion using intestinal segments, either small or large intestine. With the incorporation of laser technology in urology, new therapeutic possibilities have been opened for the section of these ureteral intestinal stenosis. Various types of laser had been employed to perform the incision, Nd:YAG, KTP:YAG, Ho:YAG, Er:YAG, and Th:YAG. The experience is limited in terms of use and results don't give clear therapeutic orientation. The section of ureteral-intestinal stenosis with laser has advantages and disadvantages, but the application of this energy source with various techniques of endoscopic section, such as the Lovaco's technique of endoluminal invagination and endoureterotomy gives satisfactory results in the short-midterm (AU)
Subject(s)
Humans , Male , Female , Lasers/therapeutic use , Laser Therapy/methods , Urethral Stricture/complications , Urethral Stricture/surgery , Cystectomy/methods , Endoscopy/methods , Intussusception/diagnosis , Intussusception/surgery , Urinary Diversion/methods , Electrocoagulation/methods , Constriction, Pathologic/therapy , Urinary Diversion/instrumentation , Urethral Stricture , Urinary Diversion/trends , Urinary DiversionABSTRACT
We investigated the effects of finasteride, a 5alpha-reductase inhibitor, on cell death machinery through the induction of apoptosis in an in vitro model for prostate cancer. Finasteride treatment of the LNCaP hormone-dependent human prostate cancer cell line caused the loss of cell viability and accelerated apoptosis in a concentration-dependent manner. The contents of immunoreactive procaspase-3 were examined by immunoblot analysis and the results suggest that the apoptosis induced by finasteride involves the increase of caspase-3 activity. Early cell changes that occur during apoptosis are associated with mitochondrial changes mediated by members of the Bcl-2 family of proteins. Therefore, Bcl-2, Bcl-xL and Bax were evaluated by the Western blot analysis. The immunoreactivity for pro-apoptotic Bax was markedly increased whereas antiapoptotic Bcl-2 and Bcl-xL expression was significantly reduced after incubation of cells with finasteride. These findings suggest that finasteride induces apoptosis in LNCaP cells via proteins of the Bcl-2 and caspase family.
Subject(s)
Apoptosis/drug effects , Caspase 3/physiology , Cholestenone 5 alpha-Reductase/antagonists & inhibitors , Enzyme Inhibitors/pharmacology , Finasteride/pharmacology , Prostatic Neoplasms/drug therapy , Proto-Oncogene Proteins c-bcl-2/physiology , bcl-2-Associated X Protein/physiology , bcl-X Protein/physiology , Cell Line, Tumor , Humans , Male , Prostatic Neoplasms/pathologyABSTRACT
OBJECTIVES: Ureteral-intestinal anastomosis represent on important problem in patients undergoing radical cystectomy with urinary diversion using intestinal segments, either small or large intestine. With the incorporation of laser technology in urology, new therapeutic possibilities have been opened for the section of these ureteral intestinal stenosis. Various types of laser had been employed to perform the incision, Nd:YAG, KTP:YAG, Ho:YAG, Er:YAG, and Th:YAG. The experience is limited in terms of use and results don't give clear therapeutic orientation. The section of ureteral-intestinal stenosis with laser has advantages and disadvantages, but the application of this energy source with various techniques of endoscopic section, such as the Lovaco's technique of endoluminal invagination and endoureterotomy gives satisfactory results in the short-midterm.
Subject(s)
Intestines/surgery , Laser Therapy , Ureter/surgery , Urinary Diversion/adverse effects , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , HumansABSTRACT
OBJECTIVES: To perform a long-term evaluation of 15 patients with unilateral essential hematuria, with the aim of determining the causes of bleeding and the response to endoscopic treatment. To design a diagnostic-therapeutic algorithm for patients with unilateral essential hematuria. METHODS: We retrospectively review the clinical data of 15 patients with unilateral essential hematuria evaluated by rigid ureterorenoscopy (15 cases), flexible ureteropyelocalycoscopy (15 cases) and percutaneous nephroscopy (3 cases). In 4 patients electric fulguration of the pyelocalicial lesions was carried out. RESULTS: 14 of the 15 patients were successfully treated endoscopically. Only one patient presented recurrence of the hematuria. Mean follow-up time was 64 months (4-168 months). No patient suffered any relevant complication secondary to the endoscopic treatment. CONCLUSIONS: The cause of bleeding in patients with unilateral essential hematuria is determined only in a few, but endoscopic treatment is successful in a high percentage of cases. We consider that upper urinary tract endoscopy, mainly flexible ureteropyelocalycoscopy, has strongly impacted the diagnosis and treatment of essential unilateral hematuria. We present a new diagnostic-therapeutic algorithm, based on the usefulness of flexible instrumentation.
Subject(s)
Endoscopy/statistics & numerical data , Hematuria/etiology , Adolescent , Adult , Algorithms , Electrocoagulation/methods , Electrocoagulation/statistics & numerical data , Female , Hemangioma/complications , Hemangioma/diagnosis , Hemangioma/surgery , Hematuria/diagnosis , Hematuria/surgery , Humans , Kidney/abnormalities , Kidney Neoplasms/complications , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Ureteroscopy/statistics & numerical dataABSTRACT
OBJETIVOS: Realizar una evaluación a largo plazo de 15 pacientes con hematuria esencial unilateral, con el fin de determinar las causas del sangrado y la respuesta obtenida con el tratamiento endoscópico efectuado. Diseñar un algoritmo diagnóstico-terapéutico para los pacientes con hematuria esencial unilateral. METODOS: Revisamos de forma retrospectiva los datos médicos de 15 pacientes con hematuria esencial unilateral que fueron evaluados mediante ureteroscopia rígida (15 casos), ureteropielocalicoscopia flexible (15 casos) y nefroscopia percutánea (3 casos). En 4 pacientes se realizó electrocoagulación de las lesiones encontradas en el sistema pielocalicial. RESULTADOS: De los 15 pacientes, 14 fueron tratados con éxito mediante endoscopia. En un solo paciente se observó la recidiva de la hematuria. El tiempo de seguimiento medio (a estos pacientes) ha sido de 64 meses (rango 4 a 168 meses). Ningún paciente ha sufrido complicación relevante en relación con el tratamiento endoscópico. CONCLUSIONES: En los pacientes con hematuria esencial unilateral la causa del sangrado se determina en pocos de ellos, pero el tratamiento endoscópico resulta exitoso en un alto porcentaje de casos. Consideramos que la endoscopia del tracto urinario superior, pero sobre todo, la ureteropielocalicoscopia flexible, ha impactado fuertemente en el diagnóstico y tratamiento de la hematuria esencial unilateral. Exponemos un nuevo algoritmo diagnóstico y terapéutico de esta entidad clínica, basado en la utilidad práctica de la instrumentación flexible (AU)
OBJECTIVES: To perform a long-term evaluation of 15 patients with unilateral essential hematuria, with the aim of determining the causes of bleeding and the response to endoscopic treatment. To design a diagnostic-therapeutic algorithm for patients with unilateral essential hematuria. METHODS: We retrospectively review the clinical data of 15 patients with unilateral essential hematuria evaluated by rigid ureterorenoscopy (15 cases), flexible ureteropyelocalycoscopy (15 cases) and percutaneous nephroscopy (3 cases). In 4 patients electric fulguration of the pyelocalicial lesions was carried out. RESULTS: 14 of the 15 patients were successfully treated endoscopically. Only one patient presented recurrence of the hematuria. Mean follow-up time was 64 months (4-168 months). No patient suffered any relevant complication secondary to the endoscopic treatment. CONCLUSIONS: The cause of bleeding in patients with unilateral essential hematuria is determined only in a few, but endoscopic treatment is successful in a high percentage of cases. We consider that upper urinary tract endoscopy, mainly flexible ureteropyelocalycoscopy, has strongly impacted the diagnosis and treatment of essential unilateral hematuria. We present a new diagnostic-therapeutic algorithm, based on the usefulness of flexible instrumentation
