Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence.

BACKGROUND: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. OBJECTIVES: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. MATERIALS AND METHODS: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0-1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student's t-test. Chi2, Fisher's exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. RESULTS: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. CONCLUSIONS: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

Balanitis Xerotica Obliterans Associated With Differentiated Penile Intraepithelial Neoplasia and "Bramble-Bush" Elastic Fibers Accumulation: A Finding Not Specific for Penicillamine Intake.

We describe the association of balanitis xerotica obliterans and differentiated penile intraepithelial neoplasia (PeIN) with dermal elastosis and "bramble-bush" elastic fibers in a diabetic patient with no history of penicillamine intake. An 84-year-old man presented with urethral obstruction syndrome that required postectomy, meatotomy, and foreskin excision. Histopathological examination revealed changes of lichen sclerosus and differentiated PeIN. Orcein staining showed striking dermal elastosis and transepidermal elimination of elastic fibers. At higher magnification, multiple serrations and buds arising from the borders of the elastic fibers were observed giving the so-called bramble-bush appearance. Balanitis xerotica obliterans is considered a premalignant disease, and 14% of patients have evidence of PeIN. The differentiated subtype can be difficult to diagnose because of the minimal basal cell atypia, so a striking dermal elastosis, which may even occur before the neoplasm becomes invasive, may facilitate its diagnosis. The term "acquired perforating dermatosis" seems appropriate to describe those cases of perforating elastosis that occurs in adults with systemic diseases. The bramble-bush appearance of elastic fibers is not specific for penicillamine-induced elastopathy, and it may occur in other diseases, such as diabetes mellitus. This peculiar morphology of elastic fibers may be related to the enzymatic imbalance between matrix metalloproteinases and lysyl oxidase, an enzyme required for the cross-linking of elastic fibers.

Use of a barbed suture for the urethro-vesical anastomosis during the learning curve of the endoscopic extraperitoneal radical prostatectomy.

OBJECTIVES: The performance of the urethrovesical anastomosis is one of the most difficult steps in urologic laparoscopy. Many different techniques have been developed to improve this step and, recently, new sutures such as the V-loc (R) barbed system have been created. In the present study we analyze the usefulness of this suture for diminishing the time employed for the anastomosis suture during the learning curve of laparoscopic radical prostatectomy. METHOD: We performed a prospective comparative study between two groups. The first group included the first 50 cases of a novel surgeon using this barbed suture, and we compared these procedures with 50 consecutives cases of an experienced surgeon. We compared preoperative parameters, surgical and suturing times, as well as drain and catheter duration, and hospital stay. RESULTS: We did not find statistically significant differences in any pre or postoperative parameters between both groups. Although surgical time was lower in the control group this difference was not statistically significant. The time used to perform the suture was lower in the study group, and we found significant differences between both groups. Neither drain nor bladder catheter times were different between groups. CONCLUSIONS: In the absence of prospective randomized trials comparing barbed or not barbed running sutures, our study shows that the use of the V-loc® system improves the times needed for the urethrovesical anastomosis during the learning curve of laparoscopic radical prostatectomy.

Uso de sutura antiretorno reabsorbible par la anastomosis uretrovesical durante la curva de aprendizaje de la prostatectomía radical endoscópica extraperitoneal / Use of a barbed suture for the urethro-vesical anastomosis during the learning curve of the endoscopic extraperitoneal radical prostatectomy

OBJETIVO: La anastomosis uretrovesical es un paso de elevada complejidad en la técnica laparoscópica. Existen múltiples técnicas para afrontar este paso, y recientemente hemos asistido al desarrollo de nuevas suturas como la sutura antirretorno V-Loc ®. Con el siguiente estudio valoramos la utilidad del uso de esta sutura para disminuir el tiempo invertido en realizar la anastomosis durante la curva de aprendizaje de la prostatectomía radical laparoscópica. MÉTODOS: Diseñamos un estudio prospectivo comparativo entre dos grupos, uno constituido por los primeros 50 casos de un cirujano novel mediante el uso de esta novedosa sutura antirretorno con 50 casos consecutivos de un cirujano experto. Se comparan los parámetros preoperatorios, los tiempos quirúrgicos y los empleados en realizar la sutura así como la permanencia de drenaje, sonda y tiempo de hospitalización. RESULTADOS: No se encontraron diferencias estadísticamente significativas en los parámetros preoperatorios entre ambos grupos. Si bien el tiempo empleado en la cirugía fue menor en el grupo control (166 minutos frente a 179 para el grupo estudio)esta diferencia no resultó estadísticamente significativa (p=0.1). El tiempo utilizado en realizar la anastomosis fue menor para el grupo en el que se utilizó la sutura V-Loc® (23.6 minutos frente a 36.1 minutos en le grupo control), y esta diferencia resultó estadísticamente significativa (p<0.001. Ni la permanencia de drenaje, ni de sonda ni el tiempo de ingreso difirió de forma estadísticamente significativa entre ambos grupos. CONCLUSIONES: A falta de estudios prospectivos randomizados comparando con una sutura continua, nuestro trabajo pone de manifiesto que la sutura continua antirretorno es una opción aceptable que consigue optimizar el tiempo empleado en la sutura de cirujanos en el inicio de su curva de aprendizaje (AU)

OBJECTIVES: The performance of the urethrovesical anastomosis is one of the most difficult steps in urologic laparoscopy. Many different techniques have been developed to improve this step and, recently, new sutures such as the V-loc (R) barbed system have been created. In the present study we analyze the usefulness of this suture for diminishing the time employed for the anastomosis suture during the learning curve of laparoscopic radical prostatectomy. METHOD: We performed a prospective comparative study between two groups. The first group included the first 50 cases of a novel surgeon using this barbed suture, and we compared these procedures with 50 consecutives cases of an experienced surgeon. We compared preoperative parameters, surgical and suturing times, as well as drain and catheter duration, and hospital stay. RESULTS: We did not find statistically significant differences in any pre or postoperative parameters between both groups. Although surgical time was lower in the control group this difference was not statistically significant. The time used to perform the suture was lower in the study group, and we found significant differences between both groups. Neither drain nor bladder catheter times were different between groups. CONCLUSIONS: In the absence of prospective randomized trials comparing barbed or not barbed running sutures, our study shows that the use of the V-loc® system improves the times needed for the urethrovesical anastomosis during the learning curve of laparoscopic radical prostatectomy (AU)

Morphological keys in the differential diagnosis of bladder inverted papilloma. Study of two types, trabecular and glandular.

OBJECTIVE: Inverted papilloma of the urinary bladder is an uncommon urothelial neoplasm that may be specially difficult to distinguish from urothelial carcinoma. METHODS: Two patients with obstructive symptoms and hematuria have been studied. In the transurethral resection, accidentally, one showed a papillary lesion in the context of nodular hyperplasia of the prostate, where as the other showed a polypoid tumor of the urinary bladder RESULTS: Histologically, in both cases, a bladder inverted papilloma was demonstrated, originating from the surface transitional epithelium. Basal cells exhibited peripheral palisading pattern in the trabecular form. In the glandular type, Dogiel or umbrella cells into the gland-like structures, were recognized. Immunohistochemical stains for p53 and Ki-67 were negative. Umbrella cells were positive for cytokeratin 20. CONCLUSIONS: Two cases of bladder inverted papilloma with relevant morphological aspects are presented, which we consider useful for the differential diagnosis with urothelial carcinoma.

Claves morfológicas en el diagnóstico diferencial del papiloma invertido vesical. Estudio de dos variedades, trabecular y glandular / Morphological keys in the differential diagnosis of bladder inverted papilloma. Study of two types, trabecular and glandular

OBJETIVO: El papiloma invertido vesical es una neoplasia urotelial poco frecuente que plantea dificultades en el diagnóstico con el carcinoma urotelial. MÉTODO: Se presentan dos pacientes, con manifestaciones clínicas de obstrucción y hematuria. En la resección transuretral, uno presentó lesión papilar en el contexto de una hiperplasia nodular prostática, mientras que en el otro se demostró una tumoración vesical polipoide. RESULTADOS: Morfológicamente en ambos casos se puso de manifiesto un papiloma invertido vesical de origen en el urotelio superficial. En la variedad trabecular, las células basales se disponían con patrón de empalizada periférica. En el tipo glandular se reconocían, dentro de las áreas seudoglandulares, células superficiales o de Dogiel. Tinciones inmunohistoquímicas para p53 y Ki-67 resultaron negativas. Las células superficiales fueron positivas con citoqueratina 20. CONCLUSIÓN: Se estudian dos variedades de papiloma invertido vesical, con aspectos morfológicos relevantes en el diagnóstico diferencial con el carcinoma urotelial (AU)

OBJECTIVE: Inverted papilloma of the urinary bladder is an uncommon urothelial neoplasm that may be specially difficult to distinguish from urothelial carcinoma. METHODS: Two patients with obstructive symptoms and hematuria have been studied. In the transurethral resection, accidentally, one showed a papillary lesion in the context of nodular hyperplasia of the prostate, where as the other showed a polypoid tumor of the urinary bladder. RESULTS: Histologically, in both cases, a bladder inverted papilloma was demonstrated, originating from the surface transitional epithelium. Basal cells exhibited peripheral palisading pattern in the trabecular form. In the glandular type, Dogiel or umbrella cells into the gland-like structures, were recognized. Immunohistochemical stains for p53 and Ki-67 were negative. Umbrella cells were positive for cytokeratin 20. CONCLUSIONS: Two cases of bladder inverted papilloma with relevant morphological aspects are presented, which we consider useful for the differential diagnosis with urothelial carcinoma (AU)

Our experience in the treatment of male stress urinary incontinence with the male Remeex system.

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment. METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with postprostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ranged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day. RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinence Impact Questionnaire (7) scores before surgery and 6 months after diminished from 68+/-7 to 10+/-3. All patients are very satisfied. CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.

Nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo masculina mediante cabestrillo suburetral regulable tipo Remeex / Our experience in the treatment of male stress urinary incontinence with the male remeex system

OBJETIVO: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo postprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, sus indicaciones terapéuticas, técnica de implantación y su adecuado ajuste.MÉTODO: Desde marzo de 2007 hasta enero de 2009 hemos intervenido a cinco varones afectos de incontinencia urinaria de esfuerzo postprostatectomía con edades comprendidas entre 57 y 71 años (media 66 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida y de un tiempo de evolución entre 2 y 10 años (media 3,5 años), precisando todos ellos entre 5 y 8 compresas diarias.RESULTADOS: Todos los pacientes se mantienen secos en un tiempo de seguimiento medio de 15,4 meses (rango 6-28 meses), precisando ocasionalmente 2 de ellos compresa de seguridad si realizan ejercicio intenso. La puntuación del Incontinence Impact Questionnaire (IIQ 7) realizado antes de la intervención y a los 6 meses después, pasa de 68 ± 7 puntos a 10 ± 3, siendo el grado de satisfacción muy elevado.CONCLUSIONES: El SRM constituye una opción terapéutica válida para la incontinencia postprostatectomía, siendo una técnica reproducible, de fácil ejecución, que permite su reajuste mediante una pequeña incisión suprapúbica bajo anestesia local y en régimen ambulatorio estricto, con una baja tasa de complicaciones proporcionando unos resultados excelentes y duraderos(AU)

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment.METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with post-prostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ran-ged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day.RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinen-ce Impact Questionnaire (7) scores befo-re surgery and 6 months after diminished from 68±7 to 10±3. All patients are very satisfied.CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results(AU)

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.(AU)

Describen la utilidad de la endoscopia virtual para diagnosticar enfermedades del tracto urinario superior / Virtual endoscopy in the diagnosis of upper urinary tract pathologies

Introducción: La patología del tracto urinario superior supone un reto diagnóstico para el urólogo. La aparición de nuevo hardware y software de adquisición y procesamiento de imágenes de tomografía computarizada (TC) ha hecho posible el desarrollo de técnicas como la que presentamos en este estudio. Material y métodos: Entre enero de 2005 y agosto de 2007 hemos incluido 57 urografías por tomografía computarizada (Uro-TC) realizadas en nuestro centro a pacientes con enfermedades del tracto urinario superior. Recogemos las indicaciones, los diagnósticos y comparamos los valores de validez interna y externa de la prueba con los de otras exploraciones radiológicas. Resultados: Realizamos un total de 57 exploraciones a 56 pacientes con edades entre los 38 y los 84 años en las que diagnosticamos 21 litiasis, 8 neoformaciones uroteliales, 2 pélvicas, 3 ureterales y 3 vesicales. En 6 pacientes con ureterohidronefrosis de etiología incierta en otras exploraciones conseguimos dilucidar la causa de la obstrucción. Diagnosticamos 2 litiasis durante el seguimiento de pacientes portadores de derivaciones urinarias, así como 5 casos de estenosis benigna. En 11 pacientes se diagnosticaron diferentes malformaciones congénitas. Los valores de validez interna de la prueba fueron superiores a los de las pruebas de imagen usadas convencionalmente para el diagnóstico de trastornos del tracto urinario superior. Conclusiones: La Uro-TC es una prueba eficiente, que está al alcance de la mayoría de centros en los que se disponga de la tecnología necesaria. Permite en casos seleccionados optimizar recursos sanitarios y agilizar el diagnóstico de la enfermedad urológica.

[Surgical treatment of renal tumours with venous extension]. / Tratamiento quirúrgico del tumor renal con extensión venosa.

OBJECTIVES: Renal carcinoma accounts for 3% of malignant urological tumors. The existence of tumor thrombus in the venous system is more infrequent, and, despite it was believed until recently its presence worsened the diagnosis of the disease, currently it is accepted that in the absence of metastatic or lymph node disease, surgery is the treatment of choice and potentially curative for these tumors. METHODS: Between June 2003 and November 2007 eight patients with renal disease and venous thrombus underwent surgery; two of them wereT3c and six T3b; in five of them surgery was carried out in association with the heart surgery team in our centre. Three of them underwent surgery with extracorporeal circulation. Mean patient age was 56 years. RESULTS: Tumor thrombus was grade I in one patient, grade II in 4 patients, grade III in one patient, and grade IV in two patients. In all patients with tumor grade > or = III, as well as two with grade II, surgery was performed in conjunction with the department of heart surgery. The operation with extracorporeal circulation, deep hypothermia, cardioplegia, and antegrade and retrograde brain perfusion was performed in grades III and IV. Midline incision was performed, with or without sternotomy, depending on the level of the thrombus. Hemorrhage was the most frequent perioperative complication. DISCUSSION: It is essential to know the exact level of the cephalic extreme of the tumor thrombus to design the proper surgical strategy; for that, we can use MRI, CT scan or ultrasound. Therefore, surgical approach, multidisciplinary cooperation and use of extracorporeal circulation will depend on such extension of the thrombus and concurrent factors of the patient. A good surgical strategy, as well as early surgery may avoid the use of venous filters preoperatively. CONCLUSIONS: Venous wall invasion seems to be related with a greater incidence of lymph node disease, but these patients are candidates to intention-to-cure radical surgery. Thrombus level is not a prognostic factor per se, but it should be taken into consideration for surgical planning. After radical surgery survival rates achieved are similar to those of tumors without venous thrombus.

Tratamiento quirúrgico del tumor renal con extensión venosa / Our experience in treatment of renal tumours with venous involvement

OBJETIVO: El carcinoma renal supone un 3% de los tumores malignos urol¨®gicos. M¨¢s infrecuente es la existencia de trombo tumoral dentro del sistema venoso y, si bien hasta hace poco se pensaba que su existencia ensombrec¨ªa el pron¨®stico de esta enfermedad, actualmente se acepta que en ausencia de enfermedad metast¨¢sica o ganglionar, la cirug¨ªa es el tratamiento de elecci¨®n y potencialmente curativo para estos tumores.MÉTODOS: Entre junio de 2003 y noviembre de 2007 hemos intervenido un total de 8 pacientes con enfermedad renal y trombo venoso, de los cuales 2 eran T3c y seis T3b, cinco de ellos fueron intervenidos junto con el servicio de cirug¨ªa cardiaca de nuestro centro. Tres de ellos fueron intervenidos con circulaci¨®n extracorp¨®rea (CEC). La media de edad de los pacientes fue de 56 años.RESULTADOS: El trombo tumoral era grado I en un paciente, grado II en 4 pacientes, grado III en 1 paciente y grado IV en dos pacientes. Todos los pacientes con grado tumoral igual o mayor de III, as¨ª como dos grado II, fueron intervenidos conjuntamente con el servicio de cirug¨ªa cardiaca, realizando en los grado III y IV la intervenci¨®n con circulaci¨®n extracorp¨®rea, hipotermia profunda con parada cardiorrespiratoria y perfusi¨®n cerebral anter¨®grada y retr¨®grada. Se realiz¨® incisi¨®n media con o sin estereotom¨ªa media dependiendo del nivel del trombo. La complicaci¨®n m¨¢s frecuente acaecida peroperatoriamente fue la hemorragia.DISCUSIÓN: Es esencial conocer el nivel exacto de la extensi¨®n cef¨¢lica del trombo tumoral para diseñar una adecuada estrategia quir¨²rgica, para lo que nos podemos valer de la resonancia magn¨¦tica (RM), de la tomograf¨ªa computerizada (TC) y de la ecocardiograf¨ªa. As¨ª el abordaje quir¨²rgico, la colaboraci¨®n multidisciplinar y el empleo de CEC depender¨¢ de dicha extensi¨®n y de los factores concomitantes presentes en el enfermo. Una buena estrategia quir¨²rgica, as¨ª como una cirug¨ªa temprana pueden evitar el uso de filtros venosos de forma preoperatoria

CONCLUSIONES: La invasión de la pared venosa parece estar relacionada con una mayor incidencia de enfermedad ganglionar, pero estos pacientes son candidatos a la cirugía radical con intención curativa. El nivel del trombo, si bien puede dificultar la cirug¨ªa, no es un factor pron¨®stico per se, y si debe ser tenido en cuenta para la planificaci¨®n quir¨²rgica. Tras la cirug¨ªa radical se alcanzan cifras de supervivencia superponibles a los tumores sin trombo venoso tumoral(AU)

OBJECTIVES: Renal carcinoma accounts for 3% of malignant urological tumors. The existence of tumor thrombus in the venous system is more infrequent, and, despite it was believed until recently its presence worsened the diagnosis of the disease, currently it is accepted that in the absence of metastatic or lymph node disease, surgery is the treatment of choice and potentially curative for these tumors.METHODS: Between June 2003 and November 2007 eight patients with renal disease and venous thrombus underwent surgery; two of them wereT3c and six T3b; in five of them surgery was carried out in association with the heart surgery team in our centre. Three of them underwent surgery with extracorporeal circulation. Mean patient age was 56 years.RESULTS: Tumor thrombus was grade I in one patient, grade II in 4 patients, grade III in one patient, and grade IV in two patients. In all patients with tumor grade ¡Ý III, as well as two with grade II, surgery was performed in conjunction with the department of heart surgery. The operation with extracorporeal circulation, deep hypothermia, cardioplegia, and antegrade and retrograde brain perfusion was performed in grades III and IV. Midline incision was performed, with or without sternotomy, depending on the level of the thrombus. Hemorrhage was the most frequent perioperative complication.DISCUSSION: It is essential to know the exact level of the cephalic extreme of the tumor thrombus to design the proper surgical strategy; for that, we can use MRI, CT scan or ultrasound. Therefore, surgical approach, multidisciplinary cooperation and use of extracorporeal circulation will depend on such extension of the thrombus and concurrent factors of the patient. A good surgical strategy, as well as early surgery may avoid the use of venous filters preoperatively(AU)

CONCLUSIONS: Venous wall invasion seems to be related with a greater incidence of lymph node disease, but these patients are candidates to intention-to-cure radical surgery. Thrombus level is not a prognostic factor per se, but it should be taken into consideration for surgical planning. After radical surgery survival rates achieved are similar to those of tumors without venous thrombus(AU)

[Penile cellulitis after oral sex]. / Celulitis de pene tras sexo oral.

OBJECTIVE: Nowadays, there is the high prevalence of sexual intercourse including oral sex, which implies some peculiarities in the infections, balanitis and ceIlulitis they may produce. METHODS: We report two new cases of penile cellulitis treated in the urology department in our hospital. DISCUSSION: We review the indications of prophylaxis, and the medical and surgical treatment both referred in the literature and carried out in our patients. CONCLUSIONS: When dealing with balanitis and penile cellulitis, the history should include explicit references to the practice of oral sex. Early medical or surgical treatment has a favourable influence on the evolution of the lesions.

Celulitis de pene tras sexo oral / Penile cellulitis after oral sex

Objetivo: En la actualidad la prevalencia de relaciones sexuales en las que se incluye sexo oral es elevada, esto conlleva una serie de peculiaridades en las infecciones, balanopostitis y celulitis, que pueden producirse en relación con estas prácticas. Métodos: Aportamos 2 nuevos casos de celulitis peneana tratados en el Servicio de Urología de nuestro hospital. Discusión: Revisamos las indicaciones de profilaxis, tratamiento médico y quirúrgico referidas en la literatura y practicadas en nuestros pacientes. Conclusiones: La anamnesis ante balanopostitis y celulitis peneanas, debe incluir referencias explícitas a la práctica de sexo oral. La precocidad en el tratamiento, tanto médico como quirúrgico, influye favorablemente en la evolución de las lesiones (AU)

Objective: Nowadays, there is the high prevalence of sexual intercourse including oral sex, which implies some peculiarities in the infections, balanitis and cellulitis they may produce. Methods: We report two new cases of penile cellulitis treated in the urology department in our hospital. Discussion: We review the indications of prophylaxis, and the medical and surgical treatment both referred in the literature and carried out in our patients. Conclusions: When dealing with balanitis and penile cellulitis, the history should include explicit references to the practice of oral sex. Early medical or surgical treatment has a favourable influence on the evolution of the lesions (AU)

Ureterohidronefrosis congénita y embarazo / Congenital ureterohydronephrosis and pregnancy

No disponible

[Greenlight KTP-laser photovaporization. Initial experience in a public hospital]. / Fotovaporización prostática con láser verde-KTP. Experiencia inicial en un hospital público.

OBJECTIVES: Despite the fact that transurethral resection of the prostate (TURP) continues being the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH), the good results obtained with the use of new energy sources have led to their use in daily practice. METHODS: Between September 2005 and January 2007, we have treated 63 patients with KTP laser photoselective vaporization of the prostate (PVP) in our service. Preoperatively we asked for IPSS, performed physical exam, digital rectal exam, abdominal , renal, bladder and prostatic ultrasound measuring postvoid residual volume, as well as flowmetry and PSA determination. Patients were revised after 1, 3, 6 and 12 months, undergoing uroflowmetry, IPSS, ultrasound and PSA; a satisfaction survey was also fulfilled at this interviews. RESULTS: Mean age was 67 years (range 58-85) and mean preoperative prostatic volume was 48cc (range 34-67), mean preoperative IPSS was 17.7 and mean maximum flow 8.1 mL/s. 12 patients presented post void residual volume larger than 100 mL. Most patients presented medium or high anaesthetic risk. Mean operative time was 64 minutes (range 45-95). In most cases we used just one fibre, and mean energy released was 175,000 Joules (range 85,000-24,000). Mean hospital stay was 32.2 hours (range 19-55). In postoperative revisions we could state a significant decrease of IPSS, improvement in maximum flow, and also good or very good satisfaction degree in about 80% of the patients. Only 3 of them presented hematuria that needed to be attended by the urologist, none of them needed transfusion. One patient was admitted for severe urinary infection and eight patients referred irritative low urinary tract symptoms in their first postoperative checkup. CONCLUSIONS: KTP laser PVP is a safe, reproducible technique with optimal short and middle term outcomes, which should be considered as the first choice surgical treatment in elderly patients, patients with chronic anaemic diseases or anticoagulated, and patients with high anaesthesic or surgical risk.