Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cystitis/painful bladder syndrome: a prospective, randomized, comparative study.

INTRODUCTION: Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a difficult disease to manage and creates critical limitations in patients' daily lives. Our objective was to determine the efficacy of hyperbaric oxygen (HBO) therapy in the maintenance of response after the administration of intravesical dimethyl sulfoxide (DMSO). MATERIALS AND METHODS: We conducted an open, prospective, randomized, comparative pilot study with women diagnosed with IC/PBS according to the European Society for the Study of Interstitial Cystitis criteria. In the first phase, DMSO was given to all patients. In the second phase, we used 1:1 randomization and administered HBO to 10 women. The evaluated variables were pain (through a visual analog scale), frequency and urgency of voids, nocturia, and quality of life using the O'Leary-Sant Interstitial Cystitis Score/Problem Index and the King's Health Questionnaire. In the second phase, we measured the length of time that clinical improvement was maintained. RESULTS: The mean age was 47.6 years (SD 18.4). Out of 20 patients, 14 experienced clinical improvement after DMSO in all of the evaluated symptoms (p < 0.05; 95% CI). After the second phase, all patients who received HBO had a more substantive and prolonged maintenance of the effects of DMSO. CONCLUSIONS: In this study, HBO improved the maintenance of the beneficial effects of DMSO among women with IC/PBS.

Laparoscopic radiofrequency for small renal masses. What is the best imaging technique?

OBJECTIVES: The diagnosis of low clinical stage renal cancer has risen up during the last years thanks to the advances on radiological imaging tools. As a result, several minimally invasive techniques have appeared which offer the same oncological results than conventional/laparoscopic surgery without their morbidity. One of these techniques is percutaneous radiofrequency (RF). In this paper we expose the oncological and functional outcomes of percutaneous RF after a review of the literature. METHODS: We made a search using the principal medical libraries as the Cochrane Central of clinical controlled trials, Medline and the Excerpta Medica database.We used the following terms: "renal radiofrequency ablation US guided", "renal radiofrequency ablation CT guided ", "renal radiofrequency ablation MR guided"," renal radiofrequency ablation "," renal radiofrequency ablation image guided". A methodological and clinical expert analyzed each abstract.All studies where renal cancer or small renal masses were treated were included. We excluded series with hereditary renal cancer only or metastatic cancer, technical series and those where tumor recurrence or other oncological criteria were not evaluated. Data collection included patient age, tumor size, follow up and oncological data. The oncological data evaluated included: tumor local recurrence (radiological or pathologic evidence of residual disease after initial treatment, independently of time to recurrence, accordingly to the recommendations of the Working group on image guided tumor ablation) or distant metastases. RESULTS: There were a total of 1621 papers. Only 24 met the inclusion criteria, and we only found 1 controlled trial, and several retrospective studies and series of cases. A total of 11, 10 y 3 for US, CT and MR guided RF, respectively, with a follow up of 1-57 months, with a total of 1764 tumors in 1524 patients. Tumor size was 1 to 8.9cm and local recurrence between 0%-5.06%. CONCLUSIONS: Surgical treatment remains the "gold standard" for clinical stage I renal cancer because we do not have enough long term scientific information to be sure that percutaneous renal RF offers the same oncological results than surgery, but percutaneous renal RF is an option for those patients that are not candidates to surgery.

Radiofrecuencia percutánea renal, ¿qué técnica de imagen es la mejor? / Laparosocpic radiofrecuency for small renal masses

OBJETIVO: En la actualidad, gracias a las técnicas de diagnóstico por la imagen, se ha incrementado la cantidad de carcinomas renales (RC) de bajo estadio clínico (masas renales pequeñas, SRMs). En respuesta a ello, ha surgido una gran cantidad de técnicas mínimamente invasivas cuyo objetivo es ofrecer los mismos resultados oncológicos pero minimizar los efectos secundarios del tratamiento quirúrgico clásico o por laparoscopia. Una de estas técnicas es la Radiofrecuencia percutánea. En este trabajo se exponen las diferentes técnicas descritas para llevarla a cabo así como los resultados oncológicos y funcionales de la misma haciendo una revisión de la literatura existente. MÉTODOS: Se obtuvieron los estudios de las principales bibliotecas médicas existentes (Cochrane Central de Ensayos Controlados, Biblioteca Nacional de Medicina EE.UU. base de datos Excerpta Medica) .Para la búsqueda se utilizaron los siguientes términos: «renal radiofrequency ablation US guided», «renal radiofrequency ablation CT guided», «renal radiofrequency ablation MR guided», «renal radiofrequency ablation», «renal radiofrequency ablation image guided». Cada resumen se analiza por un experto metodológico y clínico. Se incluyeron los estudios con RC/ SRMs que fueron tratados por vía percutánea con radiofrecuencia guiada mediante US, CT o MR. Excluimos aquellas series sólo con pacientes con RC hereditario o metastásico, las series puramente técnicas y aquellas que no evaluaron la recurrencia del tumor o de otros criterios de valoración oncológicos fueron. La media de los datos relativos a la edad del paciente, tamaño del tumor, y la duración del seguimiento fueron extraídos de las series publicadas. Los resultados oncológicos que evaluamos fueron: recurrencia local del tumor (evidencia radiológica o patológica de enfermedad residual después del tratamiento inicial, sin importar el tiempo hasta la recurrencia, de acuerdo con las recomendaciones del Grupo de Trabajo sobre la ablación del tumor guiada por imágenes), o metástasis a distancia. RESULTADOS: Identificamos 1621 títulos. Después de la selección por el título y el resumen, se obtuvieron a continuación las copias completas de papel de 24 estudios que eran potencialmente elegibles para su inclusión en la revisión. De estos, se identificó sólo un estudio controlado aleatorizado, se identificaron varias series de casos y estudios retrospectivos. Un total de 11, 10 y 3 para RF guiada por ECO, TC y RMN respectivamente. Con un seguimiento global de 1-57 meses, un total de 1764 tumores en 1524 pacientes con un seguimiento de entre 1-56,4 meses. El tamaño de tumor tratado fue de 1-8,9cm siendo las tasas de recurrencia local de 0-15,06%. CONCLUSIONES: El tratamiento quirúrgico se mantiene como «patrón oro» para los tumores renales estadio clínico I, dado que actualmente no disponemos de suficiente evidencia científica a largo plazo como para aseverar que la RF percutánea puede llegar a sustituir a la cirugía, sin embargo, la RF ofrece una opción de tratamiento en aquellos pacientes que no son candidatos a cirugía con unas tasas de éxito adecuadas siempre que se haya superado la curva de aprendizaje de la técnica (AU)

OBJECTIVES: The diagnosis of low clinical stage renal cancer has risen up during the last years thanks to the advances on radiological imaging tools. As a result, several minimally invasive techniques have appeared which offer the same oncological results than conventional/laparoscopic surgery without their morbidity. One of these techniques is percutaneous radiofrequency (RF). In this paper we expose the oncological and functional outcomes of percutaneous RF after a review of the literature. METHODS: We made a search using the principal medical libraries as the Cochrane Central of clinical controlled trials, Medline and the Excerpta Medica database. We used the following terms: «renal radiofrequency ablation US guided», «renal radiofrequency ablation CT guided», «renal radiofrequency ablation MR guided», «renal radiofrequency ablation», «renal radiofrequency ablation image guided». A methodological and clinical expert analyzed each abstract.All studies where renal cancer or small renal masses were treated were included. We excluded series with hereditary renal cancer only or metastatic cancer, technical series and those where tumor recurrence or other oncological criteria were not evaluated. Data collection included patient age, tumor size, follow up and oncological data. The oncological data evaluated included: tumor local recurrence (radiological or pathologic evidence of residual disease after initial treatment, independently of time to recurrence, accordingly to the recommendations of the Working group on image guided tumor ablation) or distant metastases. RESULTS: There were a total of 1621 papers. Only 24 met the inclusion criteria, and we only found 1 controlled trial, and several retrospective studies and series of cases. A total of 11, 10 y 3 for US, CT and MR guided RF, respectively, with a follow up of 1-57 months, with a total of 1764 tumors in 1524 patients. Tumor size was 1 to 8.9cm and local recurrence between 0%-15.06%. CONCLUSIONS: Surgical treatment remains the «gold standard» for clinical stage I renal cancer because we do not have enough long term scientific information to be sure that percutaneous renal RF offersthe same oncological results than surgery, but percutaneous renal RF is an option for those patients that are not candidates to surgery (AU)

Oxigenoterapia Hiperbárica (OHB) en el manejo de la cistitis hemorrágica radioinducida / Hyperbaric Oxygen Therapy for the management of hemorrhagic radio-induced cystitis

OBJETIVO: La Cistitis rádica (CRAD) es una enfermedad inflamatoria vesical que se presenta de forma más grave como hematuria anemizante. Los tratamientos clásicos no consiguen controlar la enfermedad a medio-largo plazo ya que no actúan sobre su patogénesis. Evaluamos la respuesta clínica de pacientes con cistitis radioinducida tras ser tratados mediante Oxigenoterapia Hiperbárica.MÉTODOS: Estudio prospectivo en el que se incluyen 38 pacientes, 21 hombres y 17 mujeres, edades desde los 46 a los 75 (media de edad de 66.5 años) sometidos a radioterapia (RT) pélvica, diagnosticados de CRAD +/- proctitis radioinducida (PRAD) y que clínicamente referían hematuria, y síndrome miccional. El tratamiento se aplicó en una cámara de tipo multiplaza, los pacientes respiraban O2 al 100% a una presión ambiental de 2-2,5 ATAs (atmósferas de presión ambiental). Recibieron una media de 29.9 sesiones (rango 10-48 sesiones), el seguimiento medio fue de 56 meses (rango 4-72 meses).RESULTADOS: La hematuria se ha resuelto hasta la fecha de forma completa en 35 pacientes, un paciente presenta actualmente hematurias no anemizantes ocasionales, a razón de una 1 trimensual. Requiriendo reingreso 6 de ellos, 5 por hematuria anemizante y 1 por pielonefritis aguda obstructiva. El tratamiento fue bien tolerado por los pacientes, 1 experimentó barotrauma que requirió de miringotomía.CONCLUSIONES: La CRAD puede tratarse de forma satisfactoria mediante OHB, consiguiendo mejoría clínica, desde las primeras sesiones en la mayoría de ocasiones, con una tolerancia más que aceptable por parte de los pacientes(AU)

OBJECTIVES: Radio-induced cystitis (RADC) is an inflammatory bladder disease that presents as anemic-hematuria in its most serious form. Classic treatments can not control the disease in the mid-to-long term because they don`t treat the pathogenesis of the disease. Thus, we evaluated the effectiveness of hyperbaric oxygen (HBO) therapy as a potential treatment for patients with RADC.METHODS: This prospective study included 38 patients, 21 men and 17 women, mean age of 66.5 years (46-75), who had been subjected to pelvic radiotherapy (RT), with the diagnosis of RADC with or without radio-induced proctitis (RADP), gross hematuria and lower seurinarytract symptoms. HBO treatment was applied in a multi-place chamber; patients breathed pure oxygen (100%) at 2-2.5 atmospheres of pressure (ATAs). Patients received an average of 31.2 sessions (10-48 sessions) and the median follow-up period was 56 months (4-72 months).RESULTS: Hematuria was completely resolved in 34 of the 38 patients. After HBO 6 patients required readmission, 5 for anemic hematuria and 1 for acute obstructive pyelonephritis. In general, patients tolerated treatment well; however, one patient experienced barotrauma requiring myringotomy.CONCLUSIONS: HBO can be used to satisfactorily treat RADC, leading to clinical improvements that begin during the initial sessions in the majority of cases, and with a more than acceptable level of patient tolerance(AU)

Empleo de la oxigenoterapia hiperbárica en Urología / Hypebaric oxygen treatment in urology

OBJETIVO: La oxigenoterapia hiperbárica (OHB) se ha empleado de forma existosa en numerosas patologías que derivan de la hipoxia tisular gracias al aporte extra de oxígeno que permite a los tejidos.En este trabajo se realiza una revisión exhaustiva acerca de toda la literatura existente en 2010 en la que se emplea OHB en patología urológica.MÉTODOS: Realizamos una búsqueda en Medline introduciendo los términos “hyperbaric oxygen”, “radic cistitis”, “interstitial cistitys”, “ hemorraghic cistitys”, “urological/pelvic fistula” y “Fournier´s gangrene”.Las búsquedas se centraron en estudios en humanos únicamente publicados en cualquier idioma.RESULTADOS: 56 trabajos publicados, 1 ensayo clínico controlado aleatorizado (ECA), 7 revisiones (review) y 48 series de casos (SC) de los que tan solo uno fué prospectivo en los que se exponen a un total de 695 pacientes. Sólo en un estudio se emplearon mediciones de oxígeno tisular para definir la hipoxia. El número de las sesiones de terapia de oxígeno hiperbárico varió desde 4 hasta 44 sesiones. (media 19,2 sesiones/paciente)CONCLUSIONES: La evidencia que se extrae de la mayoría de trabajos consultados procede de series de casos, de modo que es baja, sin embrago, en la mayoría de estudios los resultados en cuanto al manejo de los pacientes es bueno o muy bueno así que parece que la OHB puede ser de gran utilidad en enfermedades urológicas que deriven de hipoxia tisular(AU)

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables.In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders.METHODS: We performed a Medline search using the terms “hyperbaric oxygen”, “radical cystitis”, “interstitial cystitis”, “hemorrhagic cystitis”, “urological/pelvic fistula” and “Fournier´s gangrene”. The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient).CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia(AU)

Hypebaric oxygen treatment in urology.

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables. In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders. METHODS: We performed a Medline search using the terms "hyperbaric oxygen", "radical cystitis", "interstitial cystitis", "hemorrhagic cystitis", "urological/pelvic fistula"and "Fournier's gangrene". The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient). CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia.

Giant bladder lithiasis: case report and bibliographic review.

OBJECTIVE: Urinary lithiasis is a very frequent urological disease but bladder lithiasis is very uncommon.Patients usually refer voiding symptoms and hematuria. The diagnosis is made after imaging tests. We report a clinical case describing a giant bladder stone and perform a bibliographic review. METHODS: A 43 year old man with the diagnosis of giant bladder stone (more than 10 cm diameter). We searched Medline using the terms: giant bladder stone, giant bladder lithiasis, bladder lithiasis, giant bladder lithiasis. RESULTS: We made the diagnosis of giant bladder stone after a simple kidney, ureter and bladder (KUB) X Ray. The treatment for this patient was a cystolithotomy. We found more than 230 reports at Medline and chose the most referred ones and the last 10 years reports. CONCLUSIONS: Giant bladder lithiasis is a very rare pathology. The gold standard for diagnosis is cystoscopy but sometimes with a KUB Xray or an ultrasound is enough. Because of its size, cistolitotomy is the correct treatment for giant bladder stone.

Litiasis vesical gigante. Presentación de un caso y revisión de la literatura / No disponible

OBJETIVO: La litiasis es una de las patologías más prevalentes en urología. Sin embargo son poco frecuentes a nivel vesical.Las litiasis vesicales producen, generalmente, síndrome miccional y hematuria y se llega al diagnóstico después de pruebas de imagen.Presentamos un caso clínico en el que se describe la litiasis vesical primaria de mayor tamaño recopilada y hacemos una revisión de la literatura existente. MÉTODOS: Presentamos un caso clínico de un hombre de 43 años de edad diagnosticado de litiasis vesical de más de 10 cm de diámetro.Realizamos una búsqueda en Medline utilizando los siguientes términos: giant bladder stone, giant bladder lithiasis, blader lithiasis, giant bladder litiasis.RESULTADO: Nuestro paciente fue diagnosticado de litiasis vesical tras realización de Rx simple de aparato urinario y sometido a cistolitotomía. Actualmente se encuentra asintomático y libre en enfermedad.Encontramos más de 232 artículos referentes a este tema en Medline de los que seleccionamos los de mayor citación y los de los últimos 10 años.CONCLUSIONES: La litiasis vesical gigante es una enfermedad muy rara que requiere diagnósticos por imagen, la prueba patrón oro para su filiación es la cistoscopia diagnóstica aunque en ocasiones, mediante una Rx simple de abdomen o ECO urológica es suficiente.Debido a su tamaño, la cistolitotomía es todavía el tratamiento de elección para esta enfermedad(AU)

OBJECTIVE: Urinary lithiasis is a very frequent urological disease but bladder lithiasis is very uncommon.Patients usually refer voiding symptoms and hematuria. The diagnosis is made after imaging tests.We report a clinical case describing a giant bladder stone and perform a bibliographic review.METHODS: A 43 year old man with the diagnosis of giant bladder stone (more than 10 cm diameter).We searched Medline using the terms: giant bladder stone, giant bladder lithiasis, bladder lithiasis, giant bladder lithiasis.RESULTS: We made the diagnosis of giant bladder stone after a simple kidney, ureter and bladder (KUB) X Ray. The treatment for this patient was a cystolithotomy.We found more than 230 reports at Medline and chose the most referred ones and the last 10 years reports.CONCLUSIONS: Giant bladder lithiasis is a very rare pathology. The gold standard for diagnosis is cystoscopy but sometimes with a KUB Xray or an ultrasound is enough.Because of its size, cistolitotomy is the correct treatment for giant bladder stone(AU)

Carcinoma neuroendocrino de c¨¦lulas grandes de vejiga. Revisi¨®n bibliogr¨¢fica / Large cell neuroendocrine carcinoma of the urinary bladder. Bibliographic review

OBJETIVO: El Carcinoma Neuroendocrino de C¨¦lulas Grandes (CNCG), es un tumor poco frecuente en vejiga. Pretendemos actualizar los criterios diagn¨®sticos, caracter¨ªsticas anatomopatol¨®gicas e inmunohistoqu¨ªmicas, pron¨®stico y tratamiento de esta patolog¨ªa.Realizamos una revisi¨®n bibliogr¨¢fica y estudio descriptivo de los casos de CNCG de vejiga publicados en la literatura internacional.RESULTADOS: Existen 17 casos publicados de CNCG de vejiga. Las variantes histol¨®gicas mixtas constituyen el 50% y muestran escasa mejor supervivencia que las puras. El 70% son ¡ÝT3 al diagn¨®stico, y presentan una supervivencia libre de enfermedad (SLE) del 25%, mientras que la SLE para los T2 es del 100%. La cistectom¨ªa radical con linfadenectom¨ªa, combinada con quimioterapia preferiblemente neoadyuvante, consigue reducir la recurrencia local y a distancia, as¨ª como aumentar la supervivencia del CNCG de vejiga.CONCLUSIONES: El CNCG de vejiga es un tumor con alta tasa de recurrencia local y a distancia, con baja supervivencia, que requiere un diagn¨®stico precoz, y tratamiento temprano y combinado(AU)

OBJECTIVES:Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is very rare. We intend to update diagnostic criteria, pathologic and immunohistochemical characteristics, prognosis and treatment options.All published articles related with LCNEC of the urinary bladder have been reviewed and a descriptive study has been done.RESULTS: A total of 17 LCNEC of the bladder has been found. The 50% of all LCNEC of the bladder are mixed histological variant. This variant implies a better prognosis than the pure variant. The 70% of LCNEC of the bladder were ¡ÝT3 at the time of diagnosis and the survival rate was 25%, whereas T2 tumors showed a survival rate of 100%. Radical cystectomy with lymphadenectomy combined with chemotherapy can sometimes reduce local and distant recurrence and improve survival of LCNEC of the bladder. CONCLUSIONS: LCNEC of the bladder is a tumor with high rate of local and distant recurrence, as well as low survival, requiring early diagnosis and aggressive combined treatment(AU)

Histiocitoma fibroso maligno de la vejiga concomitante con carcinoma in situ. Aportación de un caso / Malignant fibrous histiocytoma of the urinary bladder concomitant with carcinoma in situ: a case report

El histiocitoma fibroso maligno (HFM) es el sarcoma más común de los tejidos blandos en el adulto; sin embargo, su existencia en el tracto urinario es excepcional. Realizamos una extensa revisión de la bibliografía al respecto, habiendo encontrado hasta la actualidad 29 casos de HFM de la vejiga. Presentamos el caso de un HFM de la vejiga en un paciente con diagnóstico y seguimiento por carcinoma in situ. Describimos la forma de presentación, las variedades anatomopatológicas, las características inmunohistoquímicas, la clasificación, los factores pronósticos y el tratamiento del HFM de la vejiga(AU9

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in the adult. However, it is only very rarely found in the urinary bladder, with only 29 cases reported to date. We present a further case of MFH of the bladder occurring in a patient diagnosed with carcinoma in situ and describe the presentation, morphology, immunohistochemistry, histological grading, prognosis and treatment(AU)

[Brucella spp orchiepididymitis]. / Orquiepididimitis por Brucella spp.

OBJECTIVE: To report a brucellar orchiepididymitis case and to review the diagnosis and treatment of this pathology. METHOD: We present the case of a 62 year old man presenting with fever, testicular pain and constitutional syndrome. The diagnosis was made after ultrasound, blood cultures and anamnesis. RESULTS: The treatment was Doxiciclin six weeks and teicoplanin, the second one was replaced with ciprofloxacin. CONCLUSION: It is important to make a correct anamnesis to the patient with orchiepididymitis to identify any risk factor for brucellosis. The diagnosis is confirmed with blood cultures. The oral antibiotics are enough to cure patients.