Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy.

The aim of this study was to investigate the role of 70 Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48 months). NHT was given to 165 patients (median 3 months). Pre-RP and pre-SRT PSA, PSA doubling time, Gleason score (GS), seminal vesicle invasion (SVI) and detectable post-SRT PSA were recorded. Any detectable PSA or PSA >0.1 ng/ml + nadir was considered biochemical failure (BcF). The Charlson co-morbidity index was used to correlate co-morbidities and rectal-genitourinary toxicity. Scores from the health-related QoL EORTC QLQ-C30 and PR-25 questionnaires were also evaluated. In 116 (63%) patients, a long-lasting curative effect was indicated by undetectable PSA levels. In univariate analysis, using BcF as an outcome variable, p<0.001 was found for GS, pre-SRT PSA, SVI and detectable post-SRT PSA. Multivariate analysis showed p=0.01 for SVI, p=0.09 for GS, and detectable post-SRT PSA (p=0.01); with metastases as an outcome variable, only SVI was significant (p=0.007). Cancer-specific and overall survival were 99 and 95%, respectively. Although microscopy showed SVI or GS 8-10 in the prostatectomy specimens 17/40 (43%) and 13/29 (45%), respectively, of patients still showed undetectable PSA at long-term follow-up (median 55 months) after SRT. Likewise, 11/31 (36%) patients with pre-SRT PSA >1.0 ng/ml and 80/134 (60%) patients with PSA doubling time (PSADT) <10 still showed undetectable PSA after 50 months. Slightly elevated acute and late rectal-genitourinary grade 3-4 toxicity was observed. No association with co-morbidity/toxicity was found. EORTC QLQ-C30 scores were similar to or slightly better than reference values. SRT with 70 Gy combined with 3-month NHT results in long-term undetectable PSA in >50% of patients with recurrence after RP with acceptable rectal-genitourinary toxicity and without negatively affecting long-term QoL. Non-metastatic patients should not be disqualified from receiving SRT although presenting with poor prognostic factors at surgery.

Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

OBJECTIVE: To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS: Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS: Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

Prospective study of prostate cancer's detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml.

UNLABELLED: SUMMAR OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml. METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. EXCLUSION CRITERIA: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis/ Chi square, t-student and Fischer exact test. RESULTS: Twenty eight percent of the patients had positive biopsy for PCa. Fifty six percent were Gleason 6 and 44% Gleason 7. Group 1 had 59%(20) and Group 2 41% (13) in. In Group 1 16% had positive biopsy for PCa vs 46% in group 2 (p 0.04) RR 3.07. CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa.

Estudio prospectivo sobre la tasa de detección de cáncer de próstata en nuestro hospital en pacientes del Noroeste de México con antígeno prostático específico entre 2, 6 y 4 ng/ml / Prospective study of prostate cancer’s detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml

OBJETIVO: Encontrar la tasa de detección de Cáncer Prostático (CaP) en nuestra población con Antígeno Prostático Específico (APE) entre 2.6 y 4 ng/ml.MÉTODOS: Se incluyeron 33 pacientes consecutivos, mediana 66 años. se les realizó biopsia transrectal guiada por ultrasonido (BTR-US) con APE entre 2.6 y 4 ng/ml. Se dividieron en 2 grupos. Grupo 1: pacientes con tacto rectal (TR) normal. Grupo 2: pacientes con ligero aumento en la consistencia de la próstata. Criterios de exclusión: CaP, neoplasia intraepitelial o TR evidente de CaP. Análisis estadístico: t de student, Fischer y X2.RESULTADOS: El 28.3% (9) fue positiva para CaP. El 56% (5) presentó CaP Gleason 6 (3+3) y el 44% (4) Gleason 7 (3+4). El 59% (20) se incluyeron en el Grupo 1 y 41% en el Grupo 2. En el grupo 1 16%(3) presentaron CaP vs 46% (6) del grupo 2 (p 0.04), RR=3.07.CONCLUSIÓN: Hay indicios de que la tasa de detección del CaP en la población de estudio pueda ser menor a lo reportado en la literatura. El TR es importante en la evaluación inicial, pequeñas anormalidades incrementan 3 veces el riesgo de CaP(AU)

OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml.METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. Exclusion criteria: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis: Chi square, t-student and Fischer exact test.RESULTS: Twenty eight percent of the patients (9) had positive biopsy for PCa. Fifty six percent (5) were Gleason 6 and 44% (4) Gleason 7 (3+4). Group 1 had 59% (20) and Group 2 41% in. In Group 1 16% (3) had positive biopsy for PCa vs 46% (6) in group 2 (p 0.04) RR 3.07.CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa(AU)

The use of Butea superba (Roxb.) compared to sildenafil for treating erectile dysfunction.

OBJECTIVE: To evaluate the effect of an extract of Butea superba (Roxb.) (BS) compared to sildenafil for treating erectile dysfunction (ED). PATIENTS AND METHODS: An open label study was carried out among 32 men with organic ED to evaluate the response on the International Index of Erectile Function 5 (IIEF-5) to BS, a 'natural health' product (100 mg), compared to 50 mg of sildenafil (a phosphodiesterase-5 inhibitor). After a 1-week wash-out, responders to BS received either 100 mg starch or 100 mg of another batch of BS (double-blind). RESULTS: Of the patients in the BS group, 27 (84%) responded positively, compared with 26 (81%) in the sildenafil group. When assessing the score alone, 12 (38%) had a better score after taking BS, compared to seven (22%) after sildenafil, and eight (25%) had the same score. The results were surprising and could not be repeated in the double-blind part of the study, where no effect of BS was recorded. CONCLUSIONS: A 'natural' health product containing BS was more effective than sildenafil in the first part of the study, but in the second, using another batch of BS, the positive result could not be repeated and no effect was recorded. The conclusion is that the first preparation of BS was most likely blended with a phosphodiesterase-5 inhibitor, later confirmed by the supplier of BS (a natural health products company) after their own analysis.

[Does circumcision affect male's perception of sexual satisfaction?]. / Genitoplastia feminizante en hiperplasia suprarrenal congénita; una o dos etapas quirúrgicas?

SUMMARY OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction perception in males with stable sexual partners. METHODS: Twenty two heterosexual male adults, sexually active with a stable partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at our clinic between June 2005 and June 2006 were included in this study. Men with severe erectile dysfunction (ED) were excluded from the study. These men were surveyed to assess erectile function, penile sensitivity, esthetical penis' appearance, sexual activity and overall satisfaction before the procedure and 12 weeks after. Categorical scores were evaluated with Chi square. RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma 13.6% and esthetics 13.6%. After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, 4.5% referred it diminished and 13.5% referred no change at all. 95.5% of the patients felt better with the appearance of their penis. Almost all areas of sexual satisfaction weren't statistical significant except for the improvement in erectile function (p 0.0007) and perception of sexual events (p 0.04). This improvement on erectile function was reported as shifts from mild to normal on International Index of Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7) before the procedure and diminished to 13.6%(3). CONCLUSION: Because of our statistic limitations and mix indications for circumcision in the study, we cannot conclude that circumcision might bring certain benefit on sexual satisfaction by itself but certainly does not bring deleterious effects and, when dissatisfaction is associated with local problems, some benefit could be expected.

¿Tiene la circuncisión algún efecto en la percepción de la satisfacción sexual masculina? / Does circumcision affect male’s perception of sexual satisfaction?

OBJETIVO: Evaluar el efecto de la percepción de la satisfacción sexual en hombres, con parejas sexuales estables, posterior a la circuncisión.MÉTODOS: Veintidós hombres heterosexuales, adultos, sexualmente activos con pareja sexual estable que fueron programados para circuncisión en nuestro servicio entre Junio del 2005 y Junio del 2006 por razones medicas o estéticas fueron incluidos en este estudio. Hombres con disfunción eréctil severa fueron excluidos. Los pacientes fueron encuestados para evaluar la función eréctil, la sensibilidad del pene, la apariencia estética, etc. Esta encuesta fue realizada antes del procedimiento y 12 semanas después. Los resultados en cada rubro fueron evaluados con Chi cuadrada.RESULTADOS: Las indicaciones quirúrgicas fueron: Fimosis 50%, Balanitis 18.2%, Condiloma 13.6 % estética 13.6%. Posterior al procedimiento el 82% de los pacientes refirió aumento en la calidad de sus encuentros sexuales, 4.5% refirió que disminuyó y 13.5% que no se modificó. Noventa y cinco por ciento refirió sentirse mejor con la apariencia de su pene. Casi todas los rubros de la satisfacción sexual evaluados en las encuestas no presentaron diferencias estadísticamente significativas a excepción de la mejora en la función sexual (p=0.0007) y la percepción de eventos sexuales (p=0.04). Esta mejora en la función eréctil fue considerada como un cambio en categoría en la clasificación del índice internacional de la función eréctil 5. En 31.8%(7) de los pacientes reporto eyaculación prematura la cual disminuyo a 13.6% (3).CONCLUSIONES: Debido a nuestras limitaciones estadísticas y las indicaciones quirúrgicas heterogéneas para la realización del procedimiento en este estudio, no podemos concluir que la circuncisión traiga consigo un beneficio en la satisfacción sexual por el simple hecho de retirar el prepucio pero definitivamente no provoca efectos deletéreos y cuando la insatisfacción está asociada a problemas locales, puede esperarse algún beneficio(AU)

OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction perception in males with stable sexual partners.METHODS: Twenty two heterosexual male adults, sexually active with a stable partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at our clinic between June 2005 and June 2006 were included in this study. Men with severe erectile dysfunction (ED) were excluded from the study. These men were surveyed to assess erectile function, penile sensitivity, esthetical penis’ appearance, sexual activity and overall satisfaction before the procedure and 12 weeks after. Categorical scores were evaluated with Chi square. RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma 13.6% and esthetics 13.6%. After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, 4.5% referred it diminished and 13.5% referred no change at all. 95.5% of the patients felt better with the appearance of their penis. Almost all areas of sexual satisfaction weren’t statistical significant except for the improvement in erectile function (p 0.0007) and perception of sexual events (p 0.04). This improvement on erectile function was reported as shifts from mild to normal on International Index of Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7) before the procedure and diminished to 13.6%(3).CONCLUSION: Because of our statistic limitations and mix indications for circumcision in the study, we cannot conclude that circumcision might bring certain benefit on sexual satisfaction by itself but certainly does not bring deleterious effects and, when dissatisfaction is associated with local problems, some benefit could be expected(AU)

Have phosphodiesterase-5 inhibitors changed the indications for penile implants?

OBJECTIVE To evaluate the indications for penile prosthesis implantation in the treatment of erectile dysfunction (ED) before and after the introduction of sildenafil. PATIENTS AND METHODS Penile prosthesis implantation was indicated in 144 men with ED at our institution between 1992 and 2007; 83 (55.6%) accepted the procedure, 55 (38.2%) refused it and six (4.2%) accepted but eventually had no surgery. Sixty-seven patients were operated primarily, and the remainder were referred cases with complications after or dissatisfaction with primary operations done elsewhere. Thirty-two were operated before the introduction of sildenafil (BS) and 35 after (AS). RESULTS In the BS group the most frequent aetiology was vascular disease, with 11(34%) vs two (6%) in the AS group. The most frequent aetiology in the AS group was previous radical pelvic surgery (radical prostatectomy, sigmoidectomy, etc.) with 17 (49%) vs none in the BS group. There were no significant differences in complication rates in both groups. Satisfaction rates in patients with malleable and inflatable devices were 36 (86%) and 17 (85%), respectively. CONCLUSIONS After the introduction of oral therapy for ED there were some changes in the aetiology of refractory ED; ED after radical prostatectomy is gaining acceptance as the main reason for a penile implant.

[Does circumcision has an effect on female's perception of sexual satisfaction?]. / Tiene algún efecto la circuncisión en la percepción de la satisfacción sexual de la mujer?

OBJECTIVE: To evaluate sexual satisfaction on women who have experienced sexual intercourse with the same partner on non-circumcised and circumcised states. MATERIAL AND METHODS: A total of 19 women between 19 and 53 y/o, median age 30, in which their sexual partner was programmed for circumcision were included in this study. The survey was a validated version on the Changes on Sexual Functioning Questionnaire (CSFQ). General sexual satisfaction, pain during vaginal penetration, desire, vaginal orgasm, vaginal lubrication, sexual frequency changes in oral and/or anal sexual activities and esthetical perception on circumcised penis were surveyed before the procedure and 2 months after. RESULTS: Changes on Vaginal lubrication during intercourse were significant (p = 0.004), it diminished from 78% to 63%. There were no statistically significant differences on general sexual satisfaction, pain during vaginal penetration, desire, vaginal orgasm. CONCLUSIONS: Circumcision has either negative or positive effect on female's partner perception of sexual satisfaction.

[Localization and size as prognostic factors of response to treatment with 5% imiquimod cream in non circumcised males with penile condyloma acuminata]. / Localización y tamaño como factores pronósticos de respuesta al tratamiento con imiquimod crema al 5% en hombres no circuncidados con condiloma acuminado peneano.

OBJECTIVES: To evaluate the relevance of size and location of penile condylomatous lesions as prognostic factors to Imiquimod 5% cream treatment response in uncircumcised men. METHODS: Twenty-two patients with condylomatous lesions in the glans, prepuce and penile shaft were included in this study. Size was no exclusion criteria. Patients with lesions on scrotal, suprapubic, inguinal or perineal area were excluded from this study. Treatment with Imiquimod 5% cream 3 times per week was given and follow up was at the first and second week and afterwards every second week. Response was classified as complete when all lesions disappeared, partial when lesions diminished in more than 50% of its original size and absence of response if no change was seen or if they diminished less than 50% of its original size. RESULTS: Six patients were excluded from the study because they did not come for follow up. Mean age was 33 years (24-51). Sevenly five (12) percent of the patients had a complete response, 18.7% (3) did not have response and 6.3% (1) had partial response. A complete response was observed in 75% (9) of patients with lesions on glans and prepuce. The same response rate was observed in patients with penile shaft lesions. There was complete response in patients with lesions as big as 7 cm and as small as 0.3 cm. Response was observed between the first and fourth week. Non responders were classified after 12 weeks of treatment and alternative treatment was advocated. CONCLUSIONS: Site and size of penile lesions of condyloma acuminata had no relevance as prognostic factors for treatment response of Imiquimod 5% cream. If Imiquimod was the treatment selected, alternative therapeutic approaches should be advised if no response is seen after the fourth week of treatment.

[Extracorporeal tumorectomy and autotransplantation in a patient with a single kidney and a multicentric clear cell carcinoma]. / Enucleación extracorpórea y autotransplante en paciente con riñón único con cáncer renal multicéntrico de células claras.

OBJECTIVE: To demonstrate that "bench surgery" and autotransplantation are still alternatives in the treatment of complex renal cancer cases. METHODS: 58 y/o female with history of radical nephrectomy due to renal cancer who asked for medical attention because of back pain. Renal masses were found during her evaluation and she was referred to our service. RESULTS: Lumbar incision was the preferred approach. After removal, the kidney was irrigated with EuroCollins solution and bench surgery was performed. Cold ischemia time was 63 minutes. The kidney was transplanted into the right pelvic region. Diuresis was immediately achieved after vascular anastomosis. Lich-Gregoir ureteral implant was carried out. During the first 48 hrs no complication was reported, urine output was about 80 cc/hour. She eventually developed renal failure and after 6 sessions of hemodialysis recovered to void in the previous volume range. She had a urinary leak that was resolved with CFT-guided percutaneus drainage. Twelve months after the procedure, she has no complaints; serum creatinine is 1.6 mg/dl and CT scan shows no evidence of recurrences. CONCLUSIONS: Bench surgery is still a therapeutic alternative for the treatment of complex renal cancer cases in order to avoid dialysis.

Localización y tamaño como factores pronósticos de respuesta al tratamiento con Imiquimod crema al 5% en hombres no circuncidados con condiloma acuminado peneano / Localization and size as prognostic factors of response to treatment with 5% imiquimod cream in non circumcised with penile condyloma acuminata

Objetivo: Evaluar la importancia del tamaño y la localización como factores pronósticos en la respuesta al tratamiento con imiquimod crema al 5% de lesiones condilomatosas en el pene no circuncidado. Métodos: Se incluyeron 22 pacientes con lesiones condilomatosas en el glande, el prepucio o en el cuerpo del pene sin importar su tamaño. Los pacientes con lesiones en escroto, región púbica, ingles o región perianal fueron excluidos del estudio. Se les dió tratamiento con imiquimod crema al 5% 3 veces por semana y se evaluó la respuesta en la primera semana y en las semanas pares. Se catalogó como respuesta completa la desaparición total de las lesiones, respuesta parcial, cuando las lesiones disminuyeron en mas de un 50% y sin respuesta si no se modificaron o disminuyeron en menos del 50% de su tamaño inicial. Resultados: Seis pacientes fueron excluidos del estudio por falta de apego al tratamiento. La edad de los 16 pacientes restantes osciló entre los 24 y 51 años (media de 33). El 75%(12) de los pacientes tuvo una respuesta completa, 18.7%(3) sin respuesta y 6.3%(1) con respuesta parcial. En los pacientes con lesiones en el glande o prepucio hubo 75%(9) de respuesta completa al igual que en el grupo de los pacientes con lesiones en el cuerpo (4). Hubo respuesta completa tanto en pacientes con lesiones de 7cm como en las de 0.3 cm. Se observó que los pacientes que presentaron respuesta, fue entre la primera y la cuarta semana. Los pacientes sin respuesta fueron clasificados así después de 12 semanas y otras alternativas terapéuticas fueron sugeridas. Conclusiones: Tanto el tamaño como la localización del condiloma acuminado en el pene no tienen relevancia como factores pronósticos en la respuesta al tratamiento tópico con imiquimod crema al 5%. Si el Imiquimod es el tratamiento de elección, otras alternativas deberán considerarse cuando este no es efectivo después de la cuarta semana del inicio de su primera aplicación (AU)

Objectives: To evaluate the relevance of size and location of penile condylomatous lesions as prognostic factors to Imiquimod 5% cream treatment response in uncircumcised men. Methods: Twenty-two patients with condylomatous lesions in the glans, prepuce and penile shaft were included in this study. Size was no exclusion criteria. Patients with lesions on scrotal, suprapubic, inguinal or perineal area were excluded from this study. Treatment with Imiquimod 5% cream 3 times per week was given and follow up was at the first and second week and afterwards every second week. Response was classified as complete when all lesions disappeared, partial when lesions diminished in more than 50% of its original size and absence of response if no change was seen or if they diminished less than 50% of its original size. Results: Six patients were excluded from the study because they did not come for follow up. Mean age was 33 years (24-51). Seventy five (12) percent of the patients had a complete response, 18.7% (3) did not have response and 6.3% (I) had partial response. A complete response was observed in 75% (9) of patients with lesions on glans and prepuce. The same response rate was observed in patients with penile shaft lesions. There was complete response in patients with lesions as big as 7cm and as small as 0.3 cm. Response was observed between the first and fourth week. Non responders were classified after 12 weeks of treatment and alternative treatment was advocated. Conclusions: Site and size of penile lesions of condyloma acuminata had no relevance as prognostic factors for treatment response of Imiquimod 5% cream. If Imiquimod was the treatment selected, alternative therapeutic approaches should be advised if no response is seen after the fourth week of treatment (AU)

Enucleación extracorpórea y autotransplante en paciente con riñón único con cáncer renal multicéntrico de células claras / Extracorporeal tumorectomy and autotransplantation in a patient with a single kidney and a multicentric clear cell carcinoma

Objetivo: Demostrar que la cirugía de banco y el autotransplante continúan siendo alternativas vigentes para el tratamiento de casos complejos de cáncer renal. Métodos: Femenina de 58 años con diagnóstico de cáncer de células renales tratado con nefrectomía radical derecha 13 años antes. Acude al servicio de medicina del dolor tras presentar como único síntoma lumbalgia. En los estudios de imagen para la evaluación de la lumbalgia se realiza el hallazgo de tumoraciones en riñón izquierdo por lo que es referida a nuestro servicio. Resultados: Se realiza abordaje con lumbotomía. Se extrae pieza quirúrgica y se realiza perfusión con solución de EuroCollins y se realiza cirugía de banco. El tiempo isquemia fría antes de la anastomosis vascular fue de 63 min. Se colocó riñón en región pélvica derecha. Hubo diuresis inmediatamente posterior a anastomosis vascular. Se realizó reimplante ureteral tipo Lich-Gregoir. Cursa sus primeras 48 horas postoperatorias sin complicaciones y con diuresis en promedio de 80cc por hr. Presenta insuficiencia renal aguda, posterior a 6 sesiones de hemodiálisis diuresis normal. Presentó fuga urinaria en anastomosis ureteral que produjo urinoma que se resolvió con drenaje percutáneo guiado por TAC. Doce meses después de la cirugía la paciente esta asintomática, creatinina sérica 1.6 mg/dl depuración de creatinina de 60 ml/min, estudios de control con riñón libre de neoplasia. Conclusiones: La cirugía de banco continúa siendo una opción terapéutica para casos complejos de cáncer renal para evitar que los pacientes sean sometidos a diálisis en espera de transplante renal (AU)

Objective: To demonstrate that “bench surgery” and autotransplantation are still alternatives in the treatment of complex renal cancer cases. Methods: 58 y/o female with history of radical nephrectomy due to renal cancer who asked for medical attention because of back pain. Renal masses were found during her evaluation and she was referred to our service. Resultados: Lumbar incision was the preferred approach. After removal, the kidney was irrigated with EuroCollins solution and bench surgery was performed. Cold ischemia time was 63 minutes. The kidney was transplanted into the right pelvic region. Diuresis was immediately achieved after vascular anastomosis. Lich-Gregoir ureteral implant was carried out. During the first 48 hrs no complication was reported, urine output was about 80 cc/hour. She eventually developed renal failure and after 6 sessions of hemodialysis recovered to void in the previous volume range. She had a urinary leak that was resolved with CT-guided percutaneus drainage. Twelve months after the procedure, she has no complaints; serum creatinine is 1.6 mg/dl and CT scan shows no evidence of recurrences. Conclusiones: Bench surgery is still a therapeutic alternative for the treatment of complex renal cancer cases in order to avoid dialysis (AU)

[Urethral lithotripsy and cystolithotripsy of giant urethral stones through a transperineal approach]. / Uretrolitotricia y cistolitotricia de litos uretrales gigantes con abordajie transperineal.

OBJECTIVE: To show that a one-stage transperineal procedure may be effective in the treatment of urethral stones secondary to urethral strictures. METHODS: We present the case of a 36 y/o paraplegic male with neurogenic bladder, history of intermittent catheterization, and urethral strictures treated with internal urethrotomies several times. Imaging tests showed the presence of giant urethral and bladder stones with a concomitant bulbar urethra stricture. A one-stage transperineal approach was indicated. RESULTS: Postoperative follow up was satisfactory. The patient was discharged from the hospital one day after the surgery. At 12 months there were no signs of urethral obstruction and he continued with intermittent catheterizations uneventfully. CONCLUSION: One stage procedure was indicated because previous endourological treatments were unsuccessful. To our knowledge there is no published case of urethral stones the size we report to or its treatment with lithotripsy and litholapaxy in a one-stage transperineal approach.

Uretrolitotricia y cistolitotricia de litos uretrales gigantes con abordaje transperineal / Urethral lithotripsy and cystolithotripsy of giant urethral stones through a transperineal approach

Objetivo: Evidenciar que un procedimiento transperineal en una etapa puede ser efectivo en el tratamiento de litiasis uretral secundario a estenosis uretral. Métodos: Se presenta el caso de un paciente masculino de 36 años parapléjico, vejiga neurogénica, historia de cateterismo intermitente y antecedente de estenosis uretral recibido: 3 de mayo 2007. tratado con uretrotomías internas en múltiples ocasiones. Estudios de imagen demuestran litiasis uretral y estenosis uretral concomitante. Se decide realizar abordaje transperineal en una sola etapa. Resultados: La evolución postoperatoria fue satisfactoria y el paciente fue egresado el día posterior a la intervención. Doce meses después de la cirugía el paciente se encuentra en buenas condiciones generales, sin datos de estenosis y se realiza cateterismos intermitentes sin dificultad. Conclusión: Se realizó un procedimiento en una sola etapa a partir de los tratamientos endoscópicos previos que no fueron exitosos. No existe en nuestro conocimiento ningún caso publicado con litos uretrales del tamaño presentado en este trabajo ni su eventual tratamiento con litotricia y litolapaxia con abordaje transperineal y uretroplastía en un solo tiempo quirúrgico (AU)

Objective: To show that a one-stage transperineal procedure may be effective in the treatment of urethral stones secondary to urethral strictures. Methods: We present the case of a 36 y/o paraplegic male with neurogenic bladder, history of intermittent catheterization, and urethral strictures treated with internal urethrotomies several times. Imaging tests showed the presence of giant urethral and bladder stones with a concomitant bulbar urethra stricture. A one-stage transperineal approach was indicated. Results: Postoperative follow up was satisfactory. The patient was discharged from the hospital one day after the surgery. At 12 months there were no signs of urethral obstruction and he continued with intermittent catheterizations uneventfully. Conclusion: One stage procedure was indicated because previous endourological treatments were unsuccessful. To our knowledge there is no published case of urethral stones the size we report to or its treatment with lithotripsy and litholapaxy in a one-stage transperineal approach (AU)

Irrigación intravesical continua con amikacina como tratamiento adyuvante en la cistitis enfisematosa / Continuous bladder irrigation with amikacin as adjuvant treatment for emphysematous cystitis

OBJETIVO: Demostrar que la irrigación intravesical continua con amikacina es un tratamiento adyuvante eficaz en la terapia para la cistitis enfisematosa. MÉTODOS: Se colocó en paciente con diagnóstico de cistitis enfisematosa una sonda transuretral de 3 vías y se inicio irrigación vesical continua con Amikacina 500mg en 1L de solución fisiológica al 0.9% (500 microgramos por ml) cada 6 horas por 3 días consecutivos. RESULTADOS: Después de 3 días de tratamiento la paciente evolucionó satisfactoriamente. Se tomo nuevo TAC con contraste intravenoso e intravesical y se evidenció ausencia de gas en la pared vesical así también se obtuvo urocultivo negativo. CONCLUSIONES: El tratamiento adyuvante con amikacina con irrigación intravesical continua podría disminuir la estancia hospitalaria y mejorar rápidamente las condiciones generales del paciente así como negativizar los cultivos en un periodo menor de tiempo. Se necesita un estudio prospectivo y comparativo para valorar si esta modalidad aquí planteada produce un beneficio real comparado con la terapia convencional (AU)

OBJECTIVE: To demonstrate that continuos intravesical irrigation with amikacin is an efective adyuvant treatment in Emphisematous Cistitis therapy. METHODS: A 3 way transurethral Foley catheter was placed and a continuous intravesical irrigation was initiated with amikacin 500mg in 1L of normal saline (500 micrograms per ml) within 6 hours 4 times a day and three consecutive days. RESULTS: After 3 days of treatment the patient showed significant clinical response. A new CT scan showed the absence of gas in the bladder wall compared to the previews CT and negative urine culture was obtained. CONCLUSIONS: We established that treatment using adjuvant continuous intravesical irrigation with amikacin can reduce hospital stay and accelerate the patient’s healing process, as well as an earlier negativisation of urine cultures. A comparative prospective study is needed to evaluate if in fact this treatment variant produces a real benefit compared to conventional therapy (AU)

[The management of a patient with foreskin strangulation by the pants zipper]. / Manejo de un paciente con estrangulación de prepucio por cremallera.

OBJECTIVE: To demonstrate that strangulation of the prepuce needs immediate specialist care. METHODS: Presentation of a 8-years-old boy case with on entrapped foreskin in his pant's zipper. RESULTS: After multiple attempts to remove the zipper under sedation, the case was referred to our service. The patient was surgically treated and his evolution was good. CONCLUSIONS: Immediate care, individualization of each case, as well as the experience of the treating physician will dictate the approach to follow in each patient. Medical personnel in adult as well as pediatric emergency departments must be aware that it is a problem that requires immediate care and avoid doing empirical and/or heroic treatments.

Manejo de un paciente con estrangulación de prepucio por cremallera / The management of a patient with foreskin strangulation by the pants zipper

OBJETIVOS: Demostrar que la estrangulación del prepucio por la cremallera requiere atención inmediata por especialistas. METODOS: Presentación de un caso de un paciente de 8 años sin antecedentes de importancia que acude tras presentar estrangulación del pene con la cremallera del pantalón. RESULTADOS: Posterior a múltiples intentos de retirar la cremallera bajo sedación, el paciente decide acudir al servicio de urología. El paciente es sometido a intervención quirúrgica evolucionando satisfactoriamente. CONCLUSIONES: La eventual atención oportuna, la individualización de cada caso en particular, la experiencia del médico tratante dictara la conducta a seguir en cada paciente. Se debe hacer consciencia en el personal médico de las salas de urgencias tanto pediátricas como de adultos de que es un problema que requiere atención inmediata y se debe evitar realizar tratamientos o abordajes empíricos y/o heróicos (AU)

OBJECTIVE: To demonstrate that strangulation of the prepuce needs immediate specialist care. METHODS: Presentation of a 8-years-old boy case with on entrapped foreskin in his pant's zipper. RESULTS: After multiple attempts to remove the zipper under sedation, the case was referred to our service. The patient was surgically treated and his evolution was good. CONCLUSIONS: Immediate care, individualization of each case, as well as the experience of the treating physician will dictate the approach to follow in each patient. Medical personnel in adult as well as pediatric emergency departments must be aware that it is a problem that requires immediate care and avoid doing empirical and/or heroic treatments

[Continous bladder irrigation with amikacin as adjuvant treatment for emphysematous cystitis]. / Irrigación intravesical continua con amikacina como tratamiento adyuvante en la cistitis enfisematosa.

OBJECTIVE: To demonstrate that continuos intravesical irrigation with amikacin is an effective adyuvant treatment in Emphisematous Cistitis therapy. METHODS: A 3 way transurethral Foley catheter was placed and a continuous intravesical irrigation was initiated with amikacin 500 mg in 1L of normal saline (500 micrograms per ml) within 6 hours 4 times a day and three consecutive days. RESULTS: After 3 days of treatment the patient showed significant clinical response. A new CT scan showed the absence of gas in the bladder wall compared to the previews CT and negative urine culture was obtained. CONCLUSIONS: We established that treatment using adjuvant continuous intravesical irrigation with amikacin can reduce hospital stay and accelerate the patient's healing process, as well as an earlier negativisation of urine cultures. A comparative prospective study is needed to evaluate if in fact this treatment variant produces a real benefit compared to conventional therapy.