Reacción anafilactoide a látex tras colocación de malla transvaginal para corrección de cistocele / Anaphylactoid latex reaction after transvaginal mesh placement for cystocele correction

La incidencia de alergia al látex en la población general es del 1-2%, siendo las reacciones más frecuentemente descritas de hipersensibilidad inmediata o tipo i y tardía o tipo iv, aunque también han sido descritas reacciones de hipersensibilidad no mediadas por IgE.Presentamos el caso de una mujer de 71 años con factores de riesgo cardiovascular (HTA y DLP) e intervenida previamente de colecistectomía y cistocele que ingresa de forma programada para intervención de recidiva de cistocele grado iv tras 4 años de la primera intervención.En el postoperatorio inmediato presenta fracaso renal agudo, por lo que se retira la malla a las 24h, persistiendo deterioro progresivo del estado general con dificultad respiratoria, disminución del nivel de conciencia y empeoramiento de la función renal. Tras una exploración exhaustiva se visualiza eritema en región vulvar e inguinal, por lo que se sospecha reacción anafiláctica a sonda de látex, que se recambia por una sonda de silicona, iniciándose tratamiento con metilprednisolona intravenosa y se consulta con el servicio de Alergología, que establece finalmente el diagnóstico.La paciente requirió ingreso en la unidad de cuidados intensivos durante 10 días por insuficiencia renal aguda e insuficiencia respiratoria aguda asociadas a íleo paralítico y coagulopatía.La anafilaxia es una reacción sistémica aguda que resulta en la liberación brusca de mediadores de los mastocitos y basófilos, mediada o no por IgE. Se admite que es una reacción de hipersensibilidad sistémica grave, de inicio repentino y potencialmente mortal. Clínicamente se asocia a la aparición de manifestaciones cutáneas relacionadas con alteraciones cardiovasculares, respiratorias o gastrointestinales.

Allergy to latex in the general population is 1-2%, the most frequent reactions described being immediate or type i and late or type iv hypersensitivity, although non-IgE-mediated hypersensitivity reactions have also been described.We present the case of a 71-year-old woman with cardiovascular risk factors (HTN and PLD) and previously operated on for cholecystectomy and cystocele who was admitted on a scheduled basis for intervention for grade iv cystocele recurrence, 4 years after the first intervention.In the immediate postoperative period, she presented acute renal failure, for which the mesh was removed after 24h, her general condition progressively deteriorated with respiratory distress, decreased level of consciousness, and worsening of renal function. After an exhaustive examination, erythema was visualized in the vulvar and inguinal region, hence the suspicion of an anaphylactic reaction to a latex catheter, which was replaced by a silicone catheter. Treatment was started with intravenous methylprednisolone, and the Allergology service was consulted who finally established the diagnosis.The patient required admission to the intensive care unit for 10 days due to acute renal failure and acute respiratory failure, associated with paralytic ileus and coagulopathy.Anaphylaxis is an acute systemic reaction that results in the abrupt release of mediators from mast cells and basophils, mediated or not by IgE. It is recognized to be a severe, sudden onset, and life-threatening systemic hypersensitivity reaction. Clinically, it is associated with the appearance of skin manifestations related to cardiovascular, respiratory, or gastrointestinal disorders.

Recomendaciones sobre el uso de las instilaciones endovesicales de ácido hialurónico en el síndrome de dolor vesical / Recommendations on the use of intravesical hyaluronic acid instillations in bladder pain syndrome

Introducción El síndrome del dolor vesical (SDV) es un síndrome complejo, sin etiología claramente establecida, que engloba diferentes entidades como la cistitis intersticial. Esto conlleva dificultades para establecer una definición precisa, obtener datos de prevalencia exactos y definir criterios diagnósticos y métodos estandarizados de estudio. Tampoco existe homogeneidad sobre el tratamiento del SDV. Las instilaciones endovesicales con ácido hialurónico (AH) son una opción, sin aún recomendaciones específicas.Objetivo Sintetizar la evidencia científica sobre las opciones terapéuticas disponibles para el SDV y consensuar un plan de trabajo y unas recomendaciones para el uso de las instilaciones endovesicales con AH.La Asociación Española de Urología, a través del Grupo de Urología Funcional, Femenina y Urodinámica, generó una comisión de expertos. Esta comisión fue la encarga de revisar la literatura (evidencia), consensuar el plan de trabajo y proponer recomendaciones.ResultadosExiste una gran variabilidad en la literatura sobre el tratamiento del SDV, sin un régimen estándar de instilación endovesical con AH (frecuencia y duración del tratamiento de inicio y mantenimiento).Conclusiones Las instilaciones endovesicales de AH (dosis habitual de 40mg) son efectivas y seguras. Pueden combinarse con otras opciones, siendo aún necesario comprobar la eficacia en algunos casos. El tratamiento se divide en varias sesiones iniciales semanales, seguidas de tratamiento de mantenimiento, generalmente mensual (duración de los ciclos no establecida).Se consensuaron recomendaciones sobre el manejo del SVD, con criterios diagnóstico y pautas para el tratamiento con AH endovesical (inicio, reevaluación y seguimiento) (AU)

Introduction Bladder pain syndrome (BPS) is a complex syndrome, without a clearly defined etiology that encompasses different entities, such as interstitial cystitis. This leads to difficulties in establishing a precise definition, obtaining accurate prevalence data, and defining diagnostic criteria and standardized assessment methods. Moreover, there is no consensus regarding the treatment of BPS. Intravesical instillations with hyaluronic acid (HA) are an option, although no specific recommendations have been made yet.Objective To synthesize the scientific evidence on the therapeutic options available for BPS and to establish a work plan and recommendations for the use of intravesical instillations with HA.The Spanish Association of Urology, through the Functional, Female, and Urodynamic Urology Group, created a commission of experts. This commission was in charge of reviewing literature (evidence), agreeing on the work plan, and proposing recommendations.ResultsThere is great variability in literature on the treatment of BPS, without a standard regimen of intravesical instillation with HA (frequency and duration of initial and maintenance treatment).Conclusions Intravesical HA instillations (usual dose of 40 mg) are effective and safe. They can be combined with other options, with efficacy still to be determined in some cases. Treatment is divided into several initial weekly sessions, followed by maintenance treatment, usually monthly (unestablished duration of cycles).Recommendations on the management of BPS were agreed, with diagnostic criteria and guidelines for treatment with intravesical HA (initiation, reassessment, and follow-up) (AU)

Recommendations on the use of intravesical hyaluronic acid instillations in bladder pain syndrome.

INTRODUCTION: Bladder pain syndrome (BPS) is a complex syndrome, without a clearly defined etiology that encompasses different entities, such as interstitial cystitis. This leads to difficulties in establishing a precise definition, obtaining accurate prevalence data, and defining diagnostic criteria and standardized assessment methods. Moreover, there is no consensus regarding the treatment of BPS. Intravesical instillations with hyaluronic acid (HA) are an option, although no specific recommendations have been made yet. OBJECTIVE: To synthesize the scientific evidence on the therapeutic options available for BPS and to establish a work plan and recommendations for the use of intravesical instillations with HA. The Spanish Association of Urology, through the Functional, Female, and Urodynamic Urology Group, created a commission of experts. This commission was in charge of reviewing literature (evidence), agreeing on the work plan, and proposing recommendations. RESULTS: There is great variability in literature on the treatment of BPS, without a standard regimen of intravesical instillation with HA (frequency and duration of initial and maintenance treatment). CONCLUSIONS: Intravesical HA instillations (usual dose of 40 mg) are effective and safe. They can be combined with other options, with efficacy still to be determined in some cases. Treatment is divided into several initial weekly sessions, followed by maintenance treatment, usually monthly (unestablished duration of cycles). Recommendations on the management of BPS were agreed, with diagnostic criteria and guidelines for treatment with intravesical HA (initiation, reassessment, and follow-up).

Consenso de la Asociación Española de Urología sobre el uso de mallas en la cirugía del prolapso de órganos pélvicos / Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse

INTRODUCCIÓN: Recientemente la Food and Drug Administration ha prohibido el uso de mallas transvaginales para el tratamiento quirúrgico de los prolapsos de órganos pélvicos (POP) en Estados Unidos. Esto ha suscitado una repercusión a escala mundial en el manejo de la patología del suelo pélvico por parte de los diferentes especialistas. OBJETIVO: Lograr un consenso sobre el uso de mallas en el tratamiento quirúrgico de los POP. ADQUISICIÓN DE DATOS/EVIDENCIA: Se organizó un Comité de expertos de la Asociación Española de Urología (AEU) para una revisión de la literatura y analizar la seguridad y eficacia del uso de mallas de polipropileno en la cirugía de los POP. RESULTADOS/EVIDENCIA DE LA LITERATURA: La evidencia refleja que el uso de mallas, comparado con el uso de tejidos nativos, ofrece una mejor eficacia a expensas de nuevas complicaciones y una mayor tasa de revisiones quirúrgicas, siendo estas menores en manos de cirujanos expertos. CONCLUSIONES: La cirugía del POP debe ser realizada por cirujanos con experiencia, adecuadamente formados y en centros de referencia. El paciente debe recibir una información correcta acerca de las diferentes opciones de tratamiento. Las mallas transvaginales solo deben indicarse en casos complejos y en recidivas tras cirugía del POP. PROPUESTA AEU: Creación de una guía clínica y de un registro nacional para la evaluación a largo plazo. Elaboración de un Consentimiento Informado a disposición de todos los profesionales y pacientes, así como un plan de formación específico para conseguir una mejor capacitación en la cirugía compleja del suelo pélvico

INTRODUCTION: Recently the Food and Drug Administration has banned the use of transvaginal meshes for the surgical treatment of pelvic organ prolapse (POP) in the United States. This has caused a worldwide impact on the management of pelvic floor pathology by different specialists. OBJECTIVE: To achieve a consensus on the use of meshes in the surgical treatment of POPs. ACQUISITION OF DATA/EVIDENCE: A Committee of experts of the Spanish Association of Urology (AEU) was organized to review the literature and analyze the safety and efficacy of the use of polypropylene meshes in POP surgery. RESULTS/EVIDENCE FROM THE LITERATURE: The evidence reflects that the use of meshes, compared to the use of native tissues, offers better efficacy at the expense of new complications and a higher rate of surgical reviews, these being minor in the hands of expert surgeons. CONCLUSIONS: POP surgery must be performed by experienced surgeons, properly trained and in referral centers. The patient should receive correct information about the different treatment options. Transvaginal meshes should only be indicated in complex cases and in recurrences after POP surgery. AEU PROPOSAL: Creation of a clinical guideline and a national registry for long-term evaluation. Preparation of an Informed Consent available to all professionals and patients, as well as a specific training plan to achieve better training in complex pelvic floor surgery

Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse. / Consenso de la Asociación Española de Urología sobre el uso de mallas en la cirugía del prolapso de órganos pélvicos.

INTRODUCTION: Recently the Food and Drug Administration has banned the use of transvaginal meshes for the surgical treatment of pelvic organ prolapse (POP) in the United States. This has caused a worldwide impact on the management of pelvic floor pathology by different specialists. OBJECTIVE: To achieve a consensus on the use of meshes in the surgical treatment of POPs. ACQUISITION OF DATA/EVIDENCE: A Committee of experts of the Spanish Association of Urology (AEU) was organized to review the literature and analyze the safety and efficacy of the use of polypropylene meshes in POP surgery. RESULTS/EVIDENCE FROM THE LITERATURE: The evidence reflects that the use of meshes, compared to the use of native tissues, offers better efficacy at the expense of new complications and a higher rate of surgical reviews, these being minor in the hands of expert surgeons. CONCLUSIONS: POP surgery must be performed by experienced surgeons, properly trained and in referral centers. The patient should receive correct information about the different treatment options. Transvaginal meshes should only be indicated in complex cases and in recurrences after POP surgery. AEU PROPOSAL: Creation of a clinical guideline and a national registry for long-term evaluation. Preparation of an Informed Consent available to all professionals and patients, as well as a specific training plan to achieve better training in complex pelvic floor surgery.

Cirugía de puerto único transumbilical con instrumentos laparoscópicos convencionales en riñón en herradura / Transumbilical Single Port Surgery With Conventional Laparoscopic Instruments in Horseshoe Kidney

Introducción: La cirugía laparoscópica está teniendo una evolución natural a disminuir la agresión quirúrgica sobre la pared abdominal, sin merma de los resultados curativos y funcionales. Aunque en desarrollo, la cirugía monopuerto ha supuesto un avance en este sentido. Material y métodos: Presentamos la primera cirugía de pielolitectomía laparoscópica por puerto único en riñón en herradura, usando instrumentos rígidos convencionales. Paciente de 18 años con IMC de 19 que en las pruebas de imagen (urograma y tomografía computarizada) presenta un riñón en herradura con litiasis coraliforme izquierda y discreta ectasia calicial. Se extrae la litiasis mediante acceso umbilical con artilugio monopuerto e instrumentos rígidos convencionales. Resultados: La cirugía se completó sin complicaciones. El tiempo quirúrgico fue 110 min y el sangrado 50 cc. Al abrir el sistema urinario hubo extravasación de orina purulenta que condicionó fiebre en el postoperatorio de 38 ◦C. Durante la intervención se colocó catéter doble J por abordaje percutáneo. Fue dada de alta al tercer día de estancia. Conclusión: El acceso laparoscópico monopuerto para la cirugía de pielolitectomía en un riñón en herradura es una alternativa razonable. El uso de instrumentos convencionales rígidos facilita el desarrollo de esta cirugía con una buena triangulación, sin conflicto de manos y seguridad para el paciente (AU)

Introduction: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. Material and methods: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. Results: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 ◦C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. Conclusion: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney isa reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient (AU)

Transumbilical single port surgery with conventional laparoscopic instruments in horseshoe kidney.

INTRODUCTION: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.

[Anatomical and technical foundations of the non-hemorrhagic treatment of simple hydrocele. Technical contributions]. / Fundamentos anatómicos y técnicos del tratamiento no hemorrágico del hidrocele simple. Aportaciones técnicas.

The efficacy of the conventional surgical techniques in the treatment of simple hydrocele has been well-established. However, further insights into the embryological anatomy of the testis and its layers have led to the development of new surgical concepts. We have conducted a retrospective study after using an "avascular" technique (extravaginalization-marsupialization) with optimum results. 120 patients treated by the Wilkinson vaginal reversal were assessed for efficacy and complications. The working hypothesis and the principles based on embryological anatomy are discussed. The results and relevant data of the treated group of patients are presented.