RESUMEN
Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O'Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.
RESUMEN
The study reports a case of a 57-year-old female patient with incidental right adrenal lipoma (LA). The tumor was detected by ultrasound (US) and confirmed by computed tomography (CT). Due to the size of the mass, it was decided to perform a laparoscopic adrenalectomy. During the differential microscopic diagnosis, were considered adrenal lipomatous tumors, myelolipoma, angiomyolipoma and teratomas, among others. In all these neoplasms, LA is a rare tumor, with only 24 cases reported in the anglo-saxon literature revised. It is a benign adrenal gland tumor with generally asymptomatic and non-functioning nature.
RESUMEN
Introducción: A lo largo de décadas se han planteado una serie de procedimientos diagnósticos de la disfunción eréctil (DE), partiendo de la historia clínica y sexual, con pruebas complementarias, algunas de ellas de carácter invasivo, debatiéndose la rentabilidad diagnóstica de dichas pruebas. Objetivos: Indagar claramente en cuáles son los procedimientos diagnósticos suficientemente fiables en la disfunción eréctil, con especial énfasis en la rentabilidad, o cambio en la presunción clínica y sexual de los test diagnósticos invasivos. Material y método: Para lograr nuestro objetivo realizaremos un estudio no comparativo, histórico, retrospectivo, entre 2 grupos prospectivos de pacientes, el A (n = 37) diagnosticados en el año 1995-1996 antes de la era de los iPDE5, y el B (n = 37) en 2012. Analizando demografía (A + B), comorbilidades (A + B), historia sexual (A + B), exploración física (A + B), analítica (A + B), respuesta a la inyección intracavernosa (A) y el empleo de cuestionarios sexuales validados (B). Resultados: En el estudio A hay diferencia entre los grupos en las variables edad, carácter total-parcial, antecedentes médico-quirúrgicos, diabetes, hipertensión arterial, vásculocardio-nefropatía, antecedentes psicológicos, toma de fármacos, tipos de erección (sobre todo la nocturna), signos de vasculopatía, niveles de glucemia y en la IIC PGE1. Dentro del estudio B hay diferencias en la diabetes mellitus, la hipertensión arterial y los niveles de glucemia. Discusión: Los factores predisponentes para la organicidad son la edad, la diabetes mellitus, la hipertensión arterial, cardio-vásculo y nefropatías. En la historia sexual el mejor parámetro para discernir entre categorías diagnósticas es la erección nocturna. La glucemia es el único parámetro analítico útil. Es el diagnóstico psicológico y el clínico los que mayor concordancia tienen con el diagnóstico de consenso. Conclusiones: Considerando suficiente base diagnóstica la evaluación global del paciente, pareja y entorno o circunstancias, predominando la valoración clínica (urológica y andrológica) además de psicosexual y social. La IIC no cambia la orientación diagnóstica, al igual que los cuestionarios sexuales validados, que sí resultan útiles en la cuantificación de la DE y en respuesta terapéutica (AU)
Introduction: Throughout decades a number of diagnostic procedures of erectile dysfunction (ED) based on the medical and sexual history have been raised, some of them with additional tests, part of them invasive, debating the diagnostic yield of these tests. Objectives: Which are sufficiently reliable diagnostic procedures in erectile dysfunction. With special emphasis on profitability, or change in the clinical and sexual presumption of invasive diagnostic tests. Material and method: To achieve our goal we will have a non-comparative, historical, retrospective, prospective study between two groups of patients, the A (n = 37) diagnosed in 1995-6 before the era of iPDE5, and B (n = 37) in 2012. By analyzing demographics (A + B), comorbidities (A + B), sexual history (A + B), physical examination (A + B), analytical (A + B), response to intracavernous injection (A) and the use of validated sexual survey (B). Results: In study A, no difference between groups in the variables age, total-partial, medical, diabetes, hypertension, cardio-vascular-renal disease, psychological history, taking drugs, erection background character types (especially at night), signs of vascular disease, blood sugar levels and the IIC PGE1. In study B there are differences in diabetes mellitus, high blood pressure and blood sugar levels. Discussion: The predisposing factors include age organicity, DM, hypertension, cardio-vascular and renal disease and. In sexual history, the best parameter to distinguish between diagnostic categories is nocturnal erection. Blood glucose is the only useful analytical parameter. It is both the psychological and clinical diagnosis who have greater concordance with the consensus diagnosis. Conclusions: Considering global assessment, partners and environment or circumstances sufficient for a diagnostic groundwork, where clinical (urology and andrology) plus psychosexual and social assessment prevail. IIC diagnosed orientation does not change, like sexual validated questionnaires, which are useful in quantifying ED and therapeutic response (AU)
