[Use of alfuzosin for expulsion of stones in the distal third of ureter]. / Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter.

INTRODUCTION: Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. MATERIALS AND METHODS: Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. RESULTS: In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days.The two stones that were not passed where the biggest ones (9 mm and 10 mm). CONCLUSIONS: Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief.

[Penile calciphylaxis: 5-year experience and literature review]. / Calcifilaxis de pene: nuestra experiencia en 5 años y revisión de la literatura científica.

INTRODUCTION: Necrosis of the penis is a rare condition that may occur as a result of infectious dissemination, circulatory disorders, or even in patients with penile prostheses. It has been reported in a few patients on dialysis, usually associated with diabetes mellitus, cholesterol embolism, and calciphylaxis. CASE REPORTS: Three patients with this condition seen at our hospital in the last 5 years are reported. CONCLUSIONS: Calciphylaxis is a rare but often fatal condition occurring in approximately 1% of patients with chronic renal failure. It is characterized by calcification of subcutaneous arteries and infarction of the subcutaneous cellular tissue and overlying skin. It is associated to a high morbidity and mortality, and diagnosis is usually based on clinical signs and symptoms. Management is controversial, particularly with regard to surgery, which may range from penectomy to local care of lesion, debridement, or antibiotic therapy.

Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter / Use of alfuzosin for expulsion of stones in the distal third of ureter

Introducción: La enfermedad litiásica ureteral afecta a alrededor del 12% de la población mundial y se ha incrementa de forma importante los últimos años en los países del oeste. De todos los cálculos ureterales, el 70% se encuentra en el tercio distal. Varios factores tienen una fuerte influencia en el paso espontáneo de los cálculos ureterales, tales como su tamaño, configuración y localización. En la actualidad, se atribuye un papel posible en la expulsión rápida de los cálculos en el tercio distal del uréter a los bloqueadores alfa. Material y métodos: Se analizó a 30 pacientes, divididos en 2 grupos de 15, con diagnóstico de litiasis del tercio distal del uréter; estos eran de 4-10 mm. Al primer grupo se le administró buscapina 10 mg cada 8 h más ketorolaco 10 mg cada 8 h y al segundo alfuzosina10 mg cada 24 h. Resultados: En el grupo 1 el tamaño de los cálculos en promedio fue de 6,4 mm; sólo4 pacientes expulsaron los cálculos y la expulsión se presentó en un promedio de 11,4 días. En el grupo 2, el tamaño promedio de los cálculos fue de 5,8 mm; se expulsaron 13 cálculos; sólo 2 pacientes tenían cálculos mayores, uno de 9 mm y el otro de 10 mm. El promedio de expulsión de cálculos fue de 3,3 días. Conclusiones: El uso de bloqueadores alfa adrenérgicos en la litiasis del tercio distal del uréter ha demostrado su eficacia en la aceleración e incluso en aumentar el número de cálculos expulsados, así como disminuir la sintomatología más rápidamente (AU)

Introduction: Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. Materials and methods: Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. Results: In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days. The two stones that were not passed where the biggest ones (9 mm and 10 mm).Conclusions: Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief (AU)

Calcifilaxis de pene: nuestra experiencia en 5 años y revisión de la literatura científica / Penile calciphylaxis: 5-year experience and literature review

Introducción: La necrosis de pene es una entidad infrecuente, que puede ocurrir como diseminación de infecciones, desórdenes circulatorios, o incluso en pacientes con prótesis peneana. Se han descrito pocos casos en pacientes sometidos a diálisis, que suelen asociarse a diabetes mellitus, embolismos de colesterol y calcifilaxis. Casos clínicos: Exponemos los casos clínicos de 3 pacientes con esta entidad, manejados en nuestro hospital durante los últimos 5 años. Conclusiones: La calcifilaxis es una rara pero frecuentemente fatal condición en pacientes con fallo renal crónica, aproximadamente en el 1% de estos pacientes; se caracteriza por calcificación de arteriolas subcutáneas e infarto del tejido celular subcutáneo y la piel adyacente. Se asocia a una elevada morbimortalidad; el diagnóstico habitualmente es clínico. En lo referente al manejo, existe controversia, sobre todo en relación con la conducta quirúrgica que se debe seguir, que va desde falectomía hasta cuidados locales de la lesión, desbridación y antibiótico terapia (AU)

Introduction: Necrosis of the penis is a rare conditon that may occur as a result of infectious dissemination, circulatory disorders, or even in patients with penile prostheses. It has been reported in a few patients on dialysis, usually associated with diabetes mellitus, cholesterolembolism, and calciphylaxis. Case reports: Three patients with this condition seen at our hospital in the last 5 years are reported. Conclusions: Calciphylaxis is a rare but often fatal condition occurring in approximately 1% of patients with chronic renal failure. It is characterized by calcification of subcutaneous arteries and infarction of the subcutaneous cellular tissue and overlying skin. It is associated to a high morbidity and mortality, and diagnosis is usually based on clinical signs and symptoms. Management is controversial, particularly with regard to surgery, which may range from penectomy to local care of lesion, debridement, or antibiotic therapy (AU)

[Liposarcoma of the espermatic cord: our experience and review of the literature]. / Liposarcoma del cordón espermático: nuestra experiencia y revisión de la literatura.

INTRODUCTION: The paratesticular tumors represent 7-10% of the intraescrotales masses. Sarcomas includes 90% of the espermatic cord malignant lessons and approximately the 3-7% are liposarcomas. MATERIAL AND METHODS: We presented our experience with two cases of paratesticular liposarcomas. RESULTS: Actually it has been reported near 161 cases of paratesticular liposarcoma. Due to the rarely of this pathology it is difficult to know its natural history and to reach conclusions of the treatment results, which one until the moment continues being radical orchiectomy with wide local resection of the surrounding soft tissues, the value of adjuvant radiation and chemotherapy is even controversial. CONCLUSIONS: Sarcomas of the espermatic cord are rare, their initial treatment is surgical, we recommended the transoperatory valuation of the surgical edges to try to diminish the recurrence frequency.

Gangrena de Fournier: Nuestra experiencia en 5 años, revisión de la literatura y valoración del índice de severidad de la Gangrena de Fournier / Fournier’s Gangrene: Our experience in 5 years, bibliographic review and assessment of the Fournier’s Gangrene severity index

OBJETIVO: La gangrena de Fournier esuna infección fulminante, que abarca las regiones genital,perineal y/o perianal. Es potencialmente letal, afectacualquier edad y género. Se ha descrito el índice deseveridad de gangrena de Fournier, el cual es útil paraevaluar el pronóstico de estos pacientes.Nuestro objetivo es reportar nuestra experiencia conesta patología en los últimos 5 años y evaluar el índicede manera retrospectiva.MÉTODOS: Se analizaron los expedientes clínicos delos pacientes con gangrena de Fournier los últimos 5años en el Hospital Universitario “Dr. José E. González”.RESULTADOS: Se revisaron 50 expedientes, el géneropredominante fue el masculino (96%), la edad promedio47.5 años, se encontró diabetes mellitus en un 80%, vejiganeurogénica 10%, HIV positivo 2%. Los sitios de origenmás frecuente de infección fueron escroto (52%) yperiné (38%), los agentes patógenos más frecuentes E.coli y Enteroccocus faecalis (48 y 28% respectivamente).El porcentaje de defunción fue del 12%, el índice deseveridad promedio fue 5.64.DISCUSIÓN: En nuestro Hospital, la gangrena de Fournieres una patología poco frecuente; a pesar de esto,se cuenta con un diagnóstico rápido y a su vez un manejoinmediato. Hasta el momento la conducta quirúrgicainmediata y el pronto inicio de antibioticoterapiacontinúan siendo la mejor opción terapéutica.CONCLUSIÓN: Existe una relación entre el índice deseveridad y la sobrevida de los pacientes, lo cual puedeconvertirlo en un parámetro útil en la evaluación de estos pacientes(AU)

OBJECTIVES: Fournier’s gangrene is adevastating infection, which includes the genital, perinealand / or perianal regions. It is potentially fatal,and affects any age and gender. The severity index forFournier’s gangrene has been described; it is useful forevaluating the prognosis of these patients.Our goal is to report our experience with this diseaseover the past 5 years and evaluate the index in retrospect. METHODS: We analyzed medical records of patientswith Fournier gangrene over the last 5 years at the UniversityHospital “Dr. José E. González”.RESULTS: We reviewed 50 cases, male gender waspredominant (96%), mean age 47.5 years, diabetesmellitus was found in 80%, neurogenic bladder in 10%,2% HIV positive. The most frequent sites of origin of infectionwere scrotum (52%) and perineum (38%), themost common pathogen E. coli and Enteroccocus faecalis(48 and 28% respectively). The death rate was 12%.The average severity index was 5.64.DISCUSSION: In our hospital, Fournier’s gangrene israre. Nevertheless, there is a rapid diagnosis protocoland therapeutic management is performed immediately.Until now, the immediate surgical treatment and earlyinitiation of antibiotic therapy remains the best therapeuticoption.CONCLUSION: There is a relationship between the indexof severity and patient survival, which may becomea useful parameter in evaluating these patients(AU)

Liposarcoma del cordón espermático: Nuestra experiencia y revisión de la literatura / Liposarcoma of the espermatic cord: Our experience and review of the literature

Introduccion: Los tumores paratesticulares representan del 7-10% de las masas intraescrotales. Los sarcomas abarcan el90% de las lesiones malignas del cordón espermático y de estas aproximadamente el 3-7% son liposarcomas. Material y métodos: Presentamos nuestra experiencia con dos casos de liposarcomas paratesticulares. Resultados: Hasta la fecha hay reportados cerca de 161 casos de liposarcoma paratesticular. Debido a lo raro de esta patologíaes difícil conocer la historia natural y llegar a conclusiones acerca de los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con excisión amplia de los tejidos locales y el papel de la radio y quimioterapia aún es controversial. Conclusiones: Los sarcomas del cordón espermático son neoplasias raras, su manejo inicial es quirúrgico, recomendamos la valoración transoperatoria de los bordes quirúrgicos para tratar de disminuir la frecuencia de reincidencias (AU)

Introduction: The paratesticular tumors represent 7-10% of the intraescrotales masses. Sarcomas includes 90% of the espermatic cord malignant lessons and approximately the 3-7% are liposarcomas. Material and methods: We presented our experience with two cases of paratesticular liposarcomas. Results: Actually it has been reported near 161 cases of paratesticular liposarcoma. Due to the rarely of this pathology it is difficult to know its natural history and to reach conclusions of the treatment results, which one until the moment continues being radical orchiectomy with wide local resection of the surrounding soft tissues, the value of adjuvant radiation and chemotherapy is even controversial. Conclusions: Sarcomas of the espermatic cord are rare, their initial treatment is surgical, we recommended the transoperatory valuation of the surgical edges to try to diminish the recurrence frequency (AU)