Programas de fuerza en la arquitectura muscular del cuádriceps femoral: revisión sistemática / Strength programs in the muscular architecture of the quadriceps femoris: A systematic review

Introducción y objetivo: La arquitectura muscular es la disposición de los elementos contráctiles del músculo definidos como longitud del fascículo (LF), ángulo de peneación (AP), grosor muscular (GM) y área de sección transversal (ASTA). Estas se ven alteradas por las lesiones siendo en el cuádriceps uno de los grupos musculares con mayor incidencia. Por tanto, la exploración de las variables que influyen en dicha circunstancia constituye una labor relevante. El objetivo fue el de evaluar cómo afectan los entrenamientos de fuerza y de fuerza resistencia en la arquitectura muscular del cuádriceps femoral. Métodos Se llevó a cabo una búsqueda sistemática sin limitación temporal, desde el 2007 hasta diciembre de 2019, en las bases de datos Medline, Sport discus, Cinahl y Scopus, obteniendo 13 ensayos clínicos después de aplicar los criterios de selección. Resultados Los resultados muestran una elevada heterogeneidad en los programas y metodologías de intervención, pero se observa que la arquitectura muscular se modifica tras un programa de fuerza, sobre todo en aquellos que utilizan métodos excéntricos (AP Recto femoral: [Pre] 12,44 ± 2,98 / [Post] 13,82 ± 3,8; GM Recto femoral [Pre] 2,1 ± 0,19 / [Post] 2,28 ± 0,31; LF Vasto Lateral [Pre] 7,82 ± 1,88 / [Post] 8,57 ± 1,14; ASTA Recto femoral [Pre] 9,21 ± 1,86 / [Post] 10,02 ± 1,98), que más frecuentemente obtienen cambios significativos y en todos los elementos arquitectónicos, e isométricos que han demostrado cambios en todos los vientres musculares del cuádriceps estudiados. Conclusión Los programas de fuerza afectan a la arquitectura muscular, sobre todo aquellos basados en ejercicios excéntricos e isométricos (AU)

Introduction and aim: Muscle architecture is the arrangement of the contractile elements of the muscle defined as fascicle length (FL), penneatión angle (PA), muscle thickness (MT) and cross-sectional area (CSA). These are altered by injuries, being the quadriceps one of the muscle groups with the highest incidence. Therefore, the exploration of the variables that influence this circumstance constitutes a relevant task. The objective was to evaluate how strength and endurance training affect the muscle architecture of the quadriceps femoris. Methods A systematic search was carried out without time limitation, where they are included from 2007 to December 2019, in the databases Medline, Sport discus, Cinahl and Scopus obtaining 13 clinical trials after applying the selection criteria. Results The results show a high heterogeneity in the programs and methodologies of intervention, but observes that the muscular architecture sees modified after a program of strength, especially in those that use eccentric methods (PA Rectus femoris [Before] 12.44 ± 2.98/[After] 13.82 ± 3.8; MT Rectus femoris [Before] 2.1 ± 0.19/[After] 2.28 ± 0.31; FL Vastus lateralis [Before] 7.82 ± 1.88/[After] 8.57 ± 1.14; CSA Rectus femoris [Before] 9.21 ± 1.86/[After] 10.02 ± 1.98), that more frequently obtain significant changes in all architectural elements, and isometric that have showed changes in all quadriceps muscles studied. Conclusion Strength programs affect muscular architecture, especially those based on eccentric and isometric exercises (AU)

Acute impact of Nordic hamstring exercise on sprint performance after 24, 48 and 72 hours.

The Nordic Hamstring Exercise (NHE) improves the strength of the hamstring muscles, as well as prevents and rehabilitates the injuries of said muscles. However, the eccentric demand of NHE may influence the athlete's performance, making compliance with these programmes difficult. The aim is to analyse the acute impact on sprint performance after the passing of 24, 48, and 72 hours respectively since an NHE-based session (4 sets of 10 repetitions) had taken place. Participants were randomly divided into an experimental group (EG) (n = 12 male participants) who carried out an NHE session and a measurement of their 30 m sprint performance in each of the three subsequent days, and a control group (CG) (n = 12 male participants) who did not take part in the NHE session. The results show a significant reduction of maximum power within 24 hours (t = 3.57, d = 0.22, P < .0273) as well of the production of high speed horizontal force up to after 48 hours (t = 4.82, d = 0.22, P < .0001) in the EG. These results may suggest separating weekly NHE sessions from competition or demanding training in which sprint performance should not be affected by at least 72 hours.

Changes in muscle architecture of biceps femoris induced by eccentric strength training with nordic hamstring exercise.

Eccentric strength training alters muscle architecture, but it is also an important factor for the prevention of hamstring injuries. The purpose was to determine the architectural adaptations of the biceps femoris long head (BFlh) after eccentric strength training with nordic hamstring exercise (NHE), followed by a subsequent detraining period. The participants in this intervention (n=23) completed a period of 13 weeks consisting of a first week of control and prior training, followed by 8 weeks of eccentric strength training with NHE, and concluding with a 4-week period of detraining. The architectural characteristics of the BFlh were measured at rest using two-dimensional ultrasound before (M1-week 1) and after (M2-week 9) the eccentric strength training, and at the end of the detraining period (M3-week 13). The muscle fascicle length significantly increased (t=-7.73, d=2.28, P<.001) in M2 compared to M1, as well as the muscle thickness (t=-5.23, d=1.54, P<.001), while the pennation angle presented a significant decrease (t=7.81, d=2.3, P<.001). The muscle fascicle length decreased significantly (t=6.07, d=1.79, P<.001) in M3 compared to M2, while the pennation angle showed a significant increase (t=-4.63, d=1.36, P<.001). The results provide evidence that NHE may cause alterations in the architectural conditions of the BFlh and may have practical implications for injury prevention and rehabilitation programs.

Nefrolitectomía percutánea de calibre reducido (NLP-CR). Algoritmo de decisión terapéutica / Small-calibre percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm

Introducción: La progresiva reducción del calibre del tracto en cirugía percutánea renal, hasta alcanzar la miniaturización, ha expandido su utilización a litiasis de menor tamaño que hasta ahora se trataban mediante litotricia extracorpórea por ondas de choque (LEOCH) y cirugía retrógrada intrarrenal (CRIR). Objetivo: Realizar una puesta al día de las diferentes técnicas de nefrolitectomía de calibre reducido (NLP-CR) analizando su eficacia, seguridad e indicaciones, así como su grado de implantación en la actualidad. Material y métodos: Realizamos una revisión en PubMed de la literatura en castellano e inglés sobre las diferentes técnicas de NLP-CR. Resultados. La NLP-CR ha disminuido la morbilidad asociada a la NLP estándar, particularmente el sangrado, y ha posibilitado la nefrolitectomía tubeless con mayor seguridad. Existen diferentes técnicas con confusa terminología (miniperc, microperc, mini-microperc, ultraminiperc) que se diferencian en el calibre que emplean y en determinados aspectos técnicos que hacen que sus indicaciones deban ser precisadas. Actualmente, la NLPCR compite con técnicas menos invasoras que la NLP estándar, como la LEOCH y la CRIR en el tratamiento de las litiasis de pequeño tamaño, pero todavía su papel no está suficientemente esclarecido y es aún motivo de debate. Conclusiones. Las indicaciones de la NLP se están expandiendo a tamaños litiásicos más pequeños debido a la miniaturización de la técnica, compitiendo en este campo con LEOCH y CRIR. Precisamos mayores estudios para establecer sus indicaciones precisas en el tratamiento de la litiasis renal

Introduction: The progressive reduction in the calibre of the tract in percutaneous kidney surgery to the point of miniaturisation has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Objective: To provide an update on the various techniques of small-calibre nephrolithotomy (SC-PCNL) analyse their efficacy, safety and indications and determine their degree of implantation at this time. Material and methods: We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. Results: The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. Conclusions: The indications for PCNL are expanding to small stone sizes due to the miniaturisation of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis

Small-calibre percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm. / Nefrolitectomía percutánea de calibre reducido (NLP-CR). Algoritmo de decisión terapéutica.

INTRODUCTION: The progressive reduction in the calibre of the tract in percutaneous kidney surgery to the point of miniaturisation has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). OBJECTIVE: To provide an update on the various techniques of small-calibre nephrolithotomy (SC-PCNL) analyse their efficacy, safety and indications and determine their degree of implantation at this time. MATERIAL AND METHODS: We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. RESULTS: The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. CONCLUSIONS: The indications for PCNL are expanding to small stone sizes due to the miniaturisation of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.

Predicción de resultados de cistoscopias en la práctica / Predicting Results of Daily-practice Cystoscopies

Objetivo: Elaborar un modelo predictivo de cáncer de vejiga en una población clínica no seleccionada derivada a cistoscopia. Materiales y métodos: Pacientes consecutivos sometidos a cistoscopia debida a sospecha o seguimiento de un cáncer de vejiga previamente diagnosticado. Todos los pacientes fueron sometidos a citología urinaria y un BTA-stat®-test (BTA). Para evitar sesgos de evaluación, BTA, citologías y cistoscopias fueron realizados de forma ciega. Usamos regresión logística para predecir los resultados de la cistoscopia a partir de citología, BTA y variables clínicas. Resultados: Entre agosto de 2011 y julio de 2012 seleccionamos 244 pacientes y 237 fueron válidos para el análisis. Un 13% fueron de nuevo diagnóstico y un 87% de seguimiento. Las sensibilidades de la citología y el BTA fueron 57,9% (IC 95%: 42,2-72,1) y 63,2% (IC 95%: 47,3-76,6) con especificidades de 84,4% (IC 95%: 78,7- 88,8) y 82,9% (IC 95%: 77,1-87,5). El modelo predictivo incluyó BTA, citología, tiempo transcurrido desde el diagnóstico del tumor previo y tratamiento con mitomicina o BGC en los últimos 3 meses. La precisión del modelo (AUC) fue 0,85 (0,78-0,92), y bajó a 0,79 al excluir el BTA (p = 0,026). En los casos de seguimiento, un umbral de 10% en las probabilidades predichas por el modelo resultó en un valor predictivo negativo de 95,7%, y 95,0% en los tumores de bajo grado. Conclusión: En un contexto de contención de costes nuestro modelo puede usarse para espaciar las cistoscopias en pacientes con tumores de bajo grado previos, resultando en un uso más eficiente de recursos del sistema de salud

Objective: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. Materials and methods: We recruited consecutive patients who underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. Results: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumor, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was 0.85 (0.78-0.92), and dropped to 0.79 when excluding the BTA-test (p = 0.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumors. Conclusion: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumors, resulting in a more efficient use of resources in the healthcare system

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

[TRUS-guided biopsy: comparison of two anesthetic methods]. / Biopsia prostática ecodirigida: comparación de dos métodos anestésicos.

PURPOSE: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine. PATIENTS AND METHODS: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. RESULTS: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p < or = 0.05). There were no significant differences in major complications. CONCLUSIONS: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.

Biopsia prostática ecodirigida: comparación de dos métodos anestésicos / Trus-guided biopsy: camparison of two anesthetic methods

Introducción: La intención de este estudio es comparar la efectividad de dos técnicas analgésicas, una oral frente al bloqueo con anestesia local de los nervios periprostáticos, en la realización de la biopsia prostática ecodirigida. Material y métodos: Un Total de 200 pacientes se han randomizado en dos grupos. Grupo I: 100 pacientes tratados con metamizol y morfina oral 30 minutos antes de la realización de la biopsia. Grupo II: 100 pacientes a los que se los ha anestesiado con mepivacaína al 2% en las bandeletas. Previamente a ambos grupos de pacientes se les suministró bromacepán 3 mg 30 minutos antes de la prueba. Después de la biopsia a los pacientes se les pidió que graduaran su dolor mediante una escala analógica visual, graduada de 0 (no dolor) a 10 dolor insoportable. Los datos obtenidos se manejaron estadísticamente con el test T de Student. Resultados: Ambos grupos no presentaron diferencias significativas con respecto a la edad, PSA y volumen prostático. Se obtuvieron en el grupo I, 3 biopsias por lóbulo (3+/-1,3), y en el II grupo 5 (5+/-1,2). En éste grupo el 95% de los pacientes no experimentaron dolor alguno tras la biopsia (VAS = 0), el 2% un dolor moderado (VAS=5-6), y el 3% un dolor intenso (VAS=7-8). Los pacientes del grupo I refirieron ningún dolor en 12,5%, dolor moderado el 42, 4% , y dolor intenso el 20% . Encontrándose diferencia significativa entre ambos grupos (p<=0,05) con respecto al dolor, pero no con respecto a las complicaciones referidas. Conclusión: La biopsia de próstata ecodirigida es una prueba muy bien tolerada bajo anestesia local con mepivacaína, disminuyendo el dolor asociado a la biopsia, lo cual permite realizar en el mismo acto una mayor toma de cilindros

Purpose: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2 % mevicaine. Patients and methods: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. Results: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3+/-1,3), and 10 in group II (5+/-1,2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS=5-6) and 3% strong pain (VAS=7-8); while patients in group I referred 12,5% no pain , 42,4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p<=0.05). There were no significant differences in major complications. Conclusions: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores

[Laparoscopic radical prostatectomy. Preliminary experience]. / Prostatectomía radical laparoscópica: experiencia preliminar.

OBJECTIVE: Laparoscopic technique has been developed with the aim to decrease the morbidity of the open radical prostatectomy. MATERIAL AND METHODS: From january 2002 to may 2002, 8 patients were treated for prostate cancer with laparoscopic radical prostatectomy. Unilateral linfadenectomy has been carried out in only one patient. We usually employ the transperitoneal technique published by the Montsouris Institute, with some modifications. RESULTS: The main surgical time was 356 minutes (540-240). Transfusion wasn't needed in any case. Intraoperative complications were: 2 bladder injuries, 1 bleeding of the epigastric artery. Postoperative complications were: 1 ileus, 2 compressive neurapraxia, 4 anastomotic fistutas. All complications were treated conservatively. No patient were converted to open surgery. Surgical limits were negatifs in all cases, and the PSA rate was less than 0.1 ng/ml in the first month follow up. CONCLUSION: Laparoscopic radical prostatectomy is a difficult technique, but we think that, the learning curve is getting lower and lower than in the first series. Oncologic results with this technique is similar to the open one. However, laparoscopic approach shows us some benefits such as less bleeding, less time catheterisation, less hospital stay, better continence, better sexual function, better stetic result, less postoperative pain, and finally an earlier back to work.

Prostatectomía radical laparoscópica: experiencia preliminar / Laparoscopic radical prostatectomy. Preliminar experience

INTRODUCCIÓN: Con intención de disminuir la morbilidad de la prostatectomá radical, se ha desarrollado la técnica de la prostatectomía radical laparoscópica (PRL). Presentamos en este trabajo nuestra experiencia preliminar. MATERIAL Y MÉTODOS: Desde el 24 de enero del 2002 hasta el 5 de mayo del 2002, hemos operado 8 pacientes. A uno realizamos linfadenectomía unilateral. Se utiliza una técnica transperitoneal con algunas variantes a la descrita en el Instituto Montsouris. RESULTADOS: El tiempo quirúrgico medio ha sido de 356 minutos (540-240). Ningún paciente ha precisado de transfusión. Complicaciones intraoperatorias: dos lesiones vesicales y una lesión de arteria epigástrica. Complicaciones post-operatorias: un ileo paralítico, dos neuropraxias, cuatro fístulas de la anastomosis. Todas se resolvieron con medidas conservadoras y ningún paciente precisó reconversión a cirugía abierta. Ninguno presentó bordes positivos. De los pacientes controlados todos tenían PSA inferior a 0,1 al mes de la intervención. CONCLUSIONES: La PRL es una técnica difícil pero creemos que la curva de aprendizaje no será tan larga como en las primeras series. Los resultados oncológicos son similares a la cirugía abierta, pero ofrece pequeñas ventajas en muchos aspectos (sangrado, días de sondaje, estancia hospitalaria, retorno a la actividad, continencia, función sexual, cosmética, dolor post-operatorio...) (AU)

[Treatment of stenosis in uretero-intestinal anastomosis]. / Tratamiento de las estenosis en las anastomosis uretero-intestinales.

UNLABELLED: We report our experience in the treatment of uretero-enteric anastomotic strictures. Our incidence in this complication is 3.8% in orthotopic bladder substitution and 8.3% in ileal conduict. MATERIAL AND METHODS: We have treated this complication in 6 patients with orthotopic bladder substitution and 4 with ileal conduict. We tried to perform a dilatation with a high pressure balloon and to place a Double-J catheter. RESULTS: In 4 cases we could not introduce the guidewire through the stricture because there was a total stop. In the others 6 cases, one is doing well without Double-J, another one did not tolerate the catheter and we performed an open surgical reanastomosis, 2 kept the catheters until their death due to metastases and the other two continue alive with their catheter periodically replaced. CONCLUSIONS: The direct uretero-enteric anastomoses present less stenoses risk. Endourological techniques should be the first option in treatment of these patients.

[Quality of life in patients treated with orthotopic bladder substitution versus cutaneous ileostomy]. / Estudio de la calidad de vida en pacientes sometidos a sustitución vesical ortotópica versus ileostomía cutánea.

PURPOSE: Nowadays, psychcological and social aspects of treatment of urinary diversion after cystectomy, have become of utmost importance. Body image, potency, continence, emotional distress and dissatisfaction, functional and social activities are majors factors to improve quality of life after surgery. The aim of this study is to compare health-related quality of life after bladder substitution with ileal conduit diversion. MATERIALS AND METHODS: We developed a questionnaire based upon a literature review, to compare health related quality of life between bladder substitution and ileal conduit (45 multiple choice mailed questionnaire). We examined functional and social activities, sexual dysfunction, urinary problems, and body image dissatisfaction. RESULTS: 78 male patients with bladder cancer, were interviewed. 91% of the questionnaires were answered, 48.7% by patients' family and 42.3% by the patients themselves. 6 patients underwent ileal conduit and 27 underwent bladder substitution. Patients with ileal consuit presented higher body image dissatisfaction than those who underwent bladder substitution. When urine leakage occurred it caused more distress to the conduit patients, indicating urinary leakage as their main problem. Bladder substitution patients did not consider continence problems as very important, they had not interrupted social activities such as travelling or seeing friends. 100% of bladder substitution patients would not mind to undergo this operation again, while only 66% of ileal conduit patients would. CONCLUSION: Health-related quality of life is higher after bladder substitution. In our opinion we should use bladder substitution as the standard method of diversion after radical cystectomy for bladder cancer.

Estudio de la calidad de vida en pacientes sometidos a sustitución vesical ortotópica versus ileostomía cutánea / Quality of life after cystectomy and bladder substitution versus ileal conducit

La calidad de vida se define como el grado de satisfacción con la vida y las circunstancias personales percibidas por la propia persona. Pretendemos comparar la calidad de vida entre los pacientes sometidos a derivación urinaria externa y sustitución vesical ortotópica, en ambos casos tras cistectomía radical. MATERIAL Y MÉTODOS: Se ha empleado un cuestionario basado en los publicados previamente, con 45 preguntas de múltiple respuesta estudiando los aspectos sociodemográficos, continencia y potencia pre y post-cirugía, estado psicológico, sexual, imagen corporal e imagen corporal percibida. RESULTADOS: Los pacientes con derivación externa sufren una grave alteración de su imagen corporal, la fuga de orina, sobre todo nocturna es la mayor causa de estrés en estos pacientes. Los pacientes con sustitución ortotópica no se encuentran preocupados por el grado de continencia que poseen, viajan más, se sienten menos cansados y ansiosos, creen que han sido mejor informados y se volverían a someter a la intervención en un 100 por ciento de los casos. CONCLUSIÓN: Creemos que en la medida de lo posible es preferible realizar una derivación continente frente a una incontinente, en base al mayor impacto de esta última en la calidad de vida de los pacientes (AU)

Tratamiento de las estenosis en las anastomosis uretero-intestinales / Treatment of uretero-enteric anastomotic strictures

Presentamos nuestra experiencia en el tratamiento de las estenosis en las anastomosis uretero-intestinales. Nuestra incidencia en esta complicación en las sustituciones vesicales ortotópicas es del 3,8 por ciento, y en las ileostomías cutáneas del 8,3 por ciento. MATERIAL Y MÉTODOS: Hemos tratado esta complicación a 6 pacientes con plastia de sustitución vesical ortotópica y 4 con ileostomía cutánea. Intentamos realizar una dilatación de la estenosis con balón de alta presión y dejar una sonda doble J. RESULTADOS: En 4 casos no logramos cateterizar la estenosis por existir un stop completo. De los otros 6 pacientes uno está bien sin doble J, otro no toleró la sonda y tuvimos que realizar una reanastomosis abierta, 2 mantuvieron la sonda hasta su fallecimiento por metástasis y otros 2 viven actualmente con sonda y cambios periódicos. CONCLUSIONES: Las anastomosis directas del uréter en el intestino tienen menos riesgo de estenosis. Las técnicas endourológicas deben ser la primera opción en el tratamiento de estos pacientes (AU)

[Ureteral stenosis of uretero-ileal anastomosis]. / Estenosis ureterales de las anastomosis urétero-ileales.

Replacement plasty allows to perform oncology surgery while maintaining body image and preserving renal function. Entero-ureteral anastomosis is a significant element in this procedure where the main responsible for the loss of renal function are stenosis, infection and reflux. Our group has performed 206 orthotopical vesical replacements (November 1981-November 1998), using a direct Wallace-type uretero-ileal anastomosis. An intussusception valve system was used as antireflux mechanism. The number of obstructions, rate of stenosis at the uretero-ileal junction and incidence of valve stenosis were all analyzed as part of the complications occurred over a follow-up period of 54 months (6-183). Findings included 6 stenosis at the uretero-intestinal junction and 2 at the intussusception valve. Two (3.8%) of the uretero-ileal stenosis were earlier and associated to fistula; one was treated with open surgery and one had a double J placed through antegrade percutaneous access. Of the remaining late four, only one was treated with a double J catheter while the other three had to be re-operated. Stenoses of the valvular system (1.2%) were solved with open surgery. From our experience, we believe that direct uretero-ileal implantation with scraping of the ureter is a safe technique with little risk for stenosis at the uretero-ileal junction. Intussusception was used a antireflux system in all cases.

[Penile incarceration with metal rings]. / Incarceración peneana por anillos metálicos.

Contribution of a case report of penial incarceration following placement of three thick metal rings and its resolution. Literature review.

Estenosis ureterales de las anastomosis urétero-ileales / Ureteral stenosis of uretero-ileal anastomosis

Con la plastia de sustitución pretendemos una cirugía oncológica y a la vez mantener la imagen corporal y preservar la función renal. La anastomosis enteroureteral es un punto muy importante de esta cirugía, ya que los principales responsables de la pérdida de dicha función renal son la estenosis, la infección y el reflujo. Hemos realizado 206 sustituciones vesicales ortotópicas (noviembre 1981 - noviembre 1998). Se realizó anastomosis uréteroileal directa tipo Wallace. Como mecanismo antirreflujo se empleó un sistema valvular mediante intususcepción. Analizamos los casos de obstrucción, la frecuencia de estenosis de la unión uré-teroileal y las estenosis valvulares ocurridos en nuestra serie como parte de las complicaciones, cuyo periodo de seguimiento fue de 54 meses (6-183).Se han hallado 6 estenosis de la unión uréterointestinal y 2 de la válvula de intususcepción. De las estenosis uréteroileales (3,8 por ciento), 2 han sido precoces asociadas a fístula, tratadas una por cirugía abierta y otra por la colocación de un doble J por vía anterógrada percutánea. De las cuatro restantes, que han sido tardías, sólo una se pudo solucionar mediante catéter doble J, el resto tuvieron que ser reintervenidas. Las estenosis del sistema valvular (1,2 por ciento) se solucionaron mediante cirugía abierta. Desde nuestra experiencia, pensamos que el implante uréteroileal directo con espatulación del uréter, es una técnica segura con poco riesgo de estenosis de la unión uréteroileal. Confiamos el sistema antirreflujo a la intususcepción (AU)

[Stenosis following a direct uretero-ileal anastomosis technique in substitutive enterocystoplasty]. / Sténoses après une technique d'anastomose urétéro-iléale directe dans les entérocystoplasties de substitution.

OBJECTIVES: Stenosis of the uretero-ileal anastomosis and reflux are the commonest causes of secondary deterioration of renal function following enterocystoplasty. Various direct anastomosis and antireflux techniques have been proposed in order to reduce the risk of stenosis and reflux. In this retrospective study, the authors evaluated the risk of stenosis and reflux after right uretero-ileal anastomosis on an invaginated ileal loop. MATERIAL AND METHODS: The authors evaluated the uretero-ileal anastomosis stenosis and reflux rate and problems of the invaginated ileo-ileal valve in 157 patients after bladder replacement enterocystoplasty. RESULTS: The anastomosis stenosis rate was 3.8% (6/157 patients) and all 6 patients were reoperated. Stenotic complications on the valve were observed in 1.2% of cases (2/157 patients). The total stenosis morbidity was 5% (8/157 patients). CONCLUSION: Direct end-to-end uretero-ileal anastomosis is the simplest technique associated with the lowest risk of stenosis. The low stenosis rate associated with invaginated valves is due to a modification of the valvular system (limitation of the mesenteric exclusion manoeuvre, external anchorage of the invagination and fixation by two lines of resorbable staples).

Incarceración peneana por anillos metálicos / Penial incarceration by metal rings

Presentamos un caso de incarceración peneana, tras la colocación de tres gruesos anillos metálicos y su resolución, así como una revisión de la literatura (AU)