[Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic]. / Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico.

INTRODUCTION: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. OBJECTIVES: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. MATERIAL AND METHODS: We performed a literature search through the database Pubmed using the terms Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. CONCLUSION: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico / Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic

Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologías. Fue descrito por primera vez por Amarenco en 1987. La manifestación clínica clásica es la neuralgia del pudendo, un dolor neuropático del área genital. Objetivos: Dar a conocer su existencia a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnostico y tratamiento. Material y método: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «Pudendal nerve», «Pudendal nerve entrapment síndrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial síndrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, española y francesa, revisando también los artículos que dichos trabajos refieren. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, fisiopatología, diagnostico clínico, ecodoppler de la arteria pudenda interna, estudios electrofisiológicos, criterios diagnósticos, terapéutica médica, tratamiento con fisioterapia y tratamiento quirúrgico. Conclusión: Es una causa poco frecuente de dolor en el suelo pélvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. Objectives: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. Materials and methods: We performed a literature search through the database “Pubmed” using the terms “Pudendal nerve”, “Pudendal nerve entrapment syndrome,” “Pelvic floor neuropathic pain”, “Pelvic floor myofascial syndrome,” “Pudendal nerve decompression”. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. Results: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. Conclusion: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)

[Myofascial pain syndrome in the pelvic floor: a common urological condition]. / Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente.

INTRODUCTION: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. OBJECTIVES: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. MATERIALS AND METHODS: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. CONCLUSION: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente / Myofascial pain syndrome in the pelvic floor: A common urological condition

Introducción: El síndrome de dolor miofascial de suelo pélvico es una entidad nosológica muy frecuente en el campo urológico y suele ser ignorada o mal diagnosticada. Objetivos: Dar a conocer la prevalencia de este síndrome a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnóstico y tratamiento. Materiales y métodos: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «trigger points», «myofascial pain», «referred pain», «infiltrations» y «physical therapy», a los que añadimos el término «pelvic floor». Entonces, seleccionamos los trabajos en lengua inglesa, española y francesa que nos podrían interesar. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, correlación anatomoclínica, epidemiología, factores de perpetuación, diagnóstico, terapéutica médica y tratamiento con fisioterapia. Conclusión: Es la causa más frecuente de dolor en el suelo pélvico y afecta, en gran medida, la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. Objectives: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. Materials and methods: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. Results: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. Conclusion: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)

Angiomiolipoma renal causante de trombo en cava y Síndrome de Budd-Chiari secundario / Renal angiomyolipoma causing inferior vena cava thrombus and secondary Budd-Chiari's syndrome

Objetivo: Se aporta un caso de angiomiolipoma renal con tres peculiaridades: origen en seno renal, trombo en cava hasta ostium de aurícula derecha y presentación clínica en forma de síndrome de Budd-Chiari. Métodos: Se realiza una presentación y comentarios de las características del caso clínico. Resultados/Conclusiones: El angiomiolipoma renal es un tumor benigno mesenquimal, poco frecuente (2-6.4% de los tumores renales), de predominio en el sexo femenino. Habitualmente surge en el parénquima renal, siendo infrecuente su origen en el seno renal. Puede afectar a estructuras venosas formando trombo tumoral en vena renal y en vena cava inferior, llegando incluso a aurícula derecha. Habitualmente es asintomático, constituyendo un hallazgo incidental en técnicas diagnósticas de imagen, pero su presentación clínica varía desde el dolor en flanco (lo más frecuente) hasta el TEP fatal, siendo excepcional su presentación como síndrome de Budd-Chiari. Debido al riesgo de TEP y muerte, el tratamiento quirúrgico (nefrectomíaradical y trombectomía) del AML con trombo en cava está indicado aun cuando sea asintomático (AU)

Objective: We report one case of renal angiomyolipoma with three characteristics: renal sinus origin, inferior vena cava tumor thrombus reaching the right atrium and Budd-Chiari syndrome. METHODS: The characteristics of the case are presented and discussed. Results/conclusions: Renal angiomyolipoma is a benign mesenchymal tumor. It is an uncommon tumor (2-6.4% of all kidney tumors), with a female predominance. Angiomyolipoma most often originate from the renal parenchyma but they can rarely originate from the renal sinus. They can involve the renal vein, the inferior vena cava and even the right atrium as a tumor thrombus. Angiomyolipoma commonly present as an incidental finding on radiographic studies, but the clinical presentation varies from flank pain to fatal pulmonary tumor embolism. The Budd-Chiari syndrome is an extremely rare presentation. Because of the risk of potentially fatal cardiopulmonary embolism and death, surgical treatment radical nephrectomy plus tumor thrombectomy) of these lesions is indicated even when they are asymptomatic (AU)

[Technical and economic reasons to set up robotic surgery in a public health system (Spanish model)]. / Razones técnicas y económicas para la implantación de la Cirugía Robótica en un Sistema Público de Salud (modelo Español).

Radical prostatectomy (RP) is today, in any of its four approaches (perineal (PRP), retropubic (ARP), laparoscopic (LRP) or robotic (RRP), the standard surgical treatment in localized prostate cancer. It looks clear that the minimum invasive approaches (laparoscopy and robotics) are able to reduce hospital stay as well as blood loss and therefore transfusion requirement. Also, laparoscopic results at mid and robotics at short term, seem to indicate, that both are safe oncologically and able to obtain same or even superior, functional results. Our objective has been to evaluate the economic impact that these techniques have to consider their definitive implantation, as well as the advantages and disadvantages of its potential implementation in our health system.

[Radical prostatectomy: open, laparoscopic and robotic. Looking for a new gold standard?]. / Prostatectomia radical abierta, laparoscópica y robótica: En busca de un nuevo gold standard?

INTRODUCTION: It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques. MATERIAL AND METHODS: We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP. open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author's criteria, a total of 73 references were selected, that were individually analyzed. RESULTS: Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent. CONCLUSIONS: Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.

Razones técnicas y económicas para la implantación de la Cirugía Robótica en un Sistema Público de Salud (modelo español) / Technical and economic reasons to set up robotic surgery in a public health system (Spanish model)

La prostatectomía radical (PR) en cualquiera de sus cuatro abordajes (perineal (PRP), retropúbico (PRA), laparoscópico (PRL) o robótico (PRR)) es hoy en día, el estándar de tratamiento quirúrgico del cáncer de próstata en estadios localizados. Parece claro, que los abordajes mínimamente invasivos (laparoscopia y robótica) son capaces de disminuir la estancia hospitalaria así como la pérdidas sanguíneas y por tanto la necesidad de transfusión. Asimismo, los resultados a medio plazo de la laparoscopia y a corto plazo de la robótica, parecen indicar, que son igual de seguras oncológicamente y capaces de conseguir los mismos o incluso superiores, resultados funcionales. Nuestro objetivo ha sido evaluar el impacto económico que tienen estas técnicas para considerar su definitiva implantación, así como las ventajas e inconvenientes de su potencial implantación en nuestro Sistema Sanitario

Radical prostatectomy (RP) is today, in any of its four approaches (perineal (PRP), retropubic (ARP), laparoscopic (LRP) or robotic (RRP), the standard surgical treatment in localized prostate cancer. It looks clear that the minimum invasive approaches (laparoscopy and robotics) are able to reduce hospital stay as well as blood loss and therefore transfusion requirement. Also, laparoscopic results at mid and robotics at short term, seem to indicate, that both are safe oncologically and able to obtain same or even superior, functional results. Our objective has been to evaluate the economic impact that these techniques have to consider their definitive implantation, as well as the advantages and disadvantages of its potential implementation in our Health System

Prostatectomía radical abierta, laparoscópica y robótica: ¿en busca de un nuevo gold standard? / Radical prostatectomy: open, laparoscopic and robotic. Looking for a new gold standard?

Introducción: En bien conocido que la prostatectomía radical (PR) es una opción excelente como tratamiento del cáncer de próstata localizado, desde el punto de vista de control oncológico. Desde hace décadas los esfuerzos de la comunidad urológica en este campo, se centran en intentar mejorar los resultados funcionales (morbilidad urinaria y sexual) tras este procedimiento. Desde el inicio de este siglo, conviven tres abordajes (abierto, robótico y laparoscópico) que hasta nuestros días pugnan por intentar alcanzar y demostrar los mejores resultados. El objetivo de esta revisión ha sido hacer una puesta al día lo más exhaustiva, rigurosa y objetiva posible, sobre los resultados oncológicos y funcionales que consiguen las tres técnicas (abordajes) de PR. Material y métodos: Hemos centrado la comparativa en cuatro apartados: resultados perioperatorios, resultados oncológicos, resultados funcionales y costes económicos. Para ellos se realizó unas búsqueda sistemática en los siguientes registros: PubMed, OVID, EMBASE y Cochrane Library, con los siguiente términos: PR Retropúbica, PR Abierta, PR Laparoscópica, PR Robótica, Función Sexual, Incontinencia Urinaria, Calidad de Vida, Costes Económicos. Se seleccionaron un total de 73 referencias, a criterio de los autores, que fueron analizadas individualmente. Resultados: La mortalidad relacionada con el procedimiento es extremadamente baja con cualquiera de las técnicas, con poco dolor postoperatorio y mínimos requerimientos analgésicos. Los resultados oncológicos, medidos en términos de márgenes quirúrgicos son comparables: PR Abierta (14-20%), PR Laparoscópica (7,4-21,9%) y PR Robótica (5,7-17,3%). En relación a resultados funcionales (función sexual y continencia urinaria) es difícil establecer comparaciones debidos a la multitud de sesgos existentes (estudios no randomizados, diferentes métodos y escalas de medida, diferentes definiciones, etc).En los estudios uni-institucionales, los resultados parecen ser equivalentes. Conclusiones: Las series de PR Laparoscópica y Robótica aún carecen de resultados maduros en términos de control bioquímico y resultados funcional a largo plazo. Parece que con estos abordajes la pérdida sanguínea y la necesidad de transfusión es menor que en cirugía abierta. La tecnología robótica aporta ventajas muy interesantes, que podrían tener un papel en homogeneizar los resultados del abordaje mínimamente invasivo, pero que aguardan validación a medio y largo plazo

Introduction: It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques. Material and methods: We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP, open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author’s criteria, a total of 73 references were selected, that were individually analyzed. Results: Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent. Conclusions:Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term

[Infection for papillomavirus in the man. Current state]. / Infección por papillomavirus en el hombre. Estado actual.

The Virus of the Human Papiloma (HPV), classically he/she has been related with infections of sexual transmission and processes wicked oncologists of the feminine genital apparatus and with less frequency of the masculine one. The new technical diagnostics, based on molecular biology (by means of polymerase chain reaction), they help to a better epidemic approach, an improvement in the I diagnose viral, and a correct therapeutic focus. The object of this work is to revise the current state of the HPV from the points of view etiopathogenics, epidemic, clinical, diagnosis, therapeutic and preservative.

Distribución de los urólogos en España: situación actual y estimación de necesidades futuras mediante un modelo predictivo

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[Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis]. / Leiomioma renal sintomático: una masa renal de difícil diagnóstico.

Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

Leiomioma renal sintomático: una masa renal de difícil diagnóstico / Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis

El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical (AU)

Fístulas urinarias: puesta al día / Urinary fistulas: an update

Las fístulas urinarias constituyen una patología poco frecuente en nuestra práctica diaria, si excluimos las vésico-vaginales. Se necesita, sin embargo, conocerlas para diagnosticarlas y tratarlas adecuadamente. De una forma bastante resumida ponemos al día el manejo de las fístulas uro-vasculares, urocutáneas, urodigestivas y uro-ginecológicas, repasando igualmente su etiología (AU)

[Urinary fistula: update]. / Fístulas urinarias: puesta al día.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be necessary to know them to be able to diagnose and treat them in the best way. In this article we classificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the possible etiologies and the correct management.

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. / Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos / Transurethral prostatic ressection syndrome. A review of its physiopathology, diagnosis and treatment

A pesar del desarrollo de técnicas no invasivas para el tratamiento de la hiperplasia benigna prostática (HBP), el tratamiento quirúrgico que, en muchas ocasiones es la resección transuretral (R.T.U.), constituye la opción terapéutica más eficaz para aquellos pacientes que no responden favorablemente a la farmacoterapia. La absorción de líquidos hipotónicos utilizados para la irrigación vesical duran-te el procedimiento pueden causar alteraciones hemodinámicas y del sistema nervioso central (S.N.C.) que, en su conjunto o por separado, se conocen como "Síndrome de reabsorción o de resección transuretral" (Síndrome R.T.U.).A pesar de que la descripción de este síndrome se produjo hace más de medio siglo, permanecen aún en debate a múltiples aspectos, tanto de su fisiopatología como de su tratamiento. Hemos llevado a cabo una revisión bibliográfica de este tema, actualizando aspectos diagnósticos y terapéuticos (AU)

[Solitary renal metastasis of primary esophageal cancer]. / Metástasis renal solitaria de un cáncer primario esofágico.

We present an unusual case of single kidney metastasis from an primary esophageal neoplasm. Its main clinical and diagnostic topics are described. They made us consider him as a good candidate for surgery. The pathological study of the nephrectomy specimen was surprising. The postoperative period was unfortunate, however.