1p36 is a chromosomal site of genomic instability in cervical intraepithelial neoplasia.

We investigated the association between progressive stages of cervical neoplasia and DNA damage in 1p36 DNA sequences of chromosome 1 in cervical epithelium using DNA breakage detection/fluorescence in situ hybridization (DBD-FISH). We used a hospital based unmatched case control study of 29 women that were grouped according to disease stage and selected according to histological diagnosis: 10 with low grade squamous intraepithelial lesions (LG-SILs), 10 with high grade SILs (HG-SILs) and nine with no cervical lesions; the 1pter sequence was used as internal control. We found a significant increase in the number of patients with HG-SIL compared to patients with LG-SILs or with no cervical lesions. 1p36 Genomic instability was validated by DBD-FISH using neutral comets. Genetic instability at specific gene loci, such as 1p36, might be characteristic of cervical cancer progression. DBD-FISH appears to be a useful approach for detecting and comparing damage to specific chromosomal regions related to the progression of cervical cancer.

Study of X-ray scattered in a phantom as function of its maximum energy during bimodal PET/CT imaging.

In a simultaneous Bimodal System with Positron Emission Tomography and Computed Tomography, the X-rays from a collimated X-ray tube are scattered over an anatomical region on the patient being scanning and cause a contamination effect on the signal received by the detectors distributed in the shape of a ring of the PET system. To study this phenomenon, each of the components of a bimodal system was modeled and simulated by the Monte Carlo method in Geant4 an X-ray beam produced in a RTW tube MCBM 65B with typical fluences used in medical diagnosis of small animals hitting a cylindrical phantom with a diameter greater than Field of View (FOV) in the tomographic center. The number of ionization events that occur in each of the phoswich detectors of the PET were obtained, the spatial distribution of the scattered X-rays was studied according to three maximum energies of the spectrum and calculation was made to find a filter that was located at the input of the phoswich detector that attenuates the X-rays by 98% and that would allow transmitting the gamma rays of annihilation also by 98%. For this, simulations were carried out using various filter materials, finding that copper is an excellent candidate and were found an optimum thicknesses between 0.5 mm and 1.3 mm, according to the average energy of the X-rays used in the different exploration techniques.

Optimization by Monte Carlo method of photon fluence from the X-ray beam spectrum in a bimodal tomographic system.

A bimodal tomographic system with a RTW MCBM 65B-50Mo X-ray tube and a XPAD3s semiconductor camera that contains 8 bars, each one with 67,200 hybrid pixels are modeled in GEANT4 simulation code. Several conical X-ray spectra were simulated, particularly a spectrum with a peak energy of 17.4 keV used in tomography on small animals. Three phantoms located in the tomographic center were added to the simulation to evaluate the image quality and its magnification based on the simulation of different photon fluences and the rotation effect of the tomographic system with an average angular velocity of 360o per minute. The images were recorded and analyzed in 2D through ROOT software toolkit in virtual XPAD3 detector. The quantitative method 20-80% of the maximum intensity of radiation was used for obtain the contouring of the phantoms, this method is used in radiotherapy and radiodiagnosis imaging. For this purpose, the images were taken to DICOM format in order to estimate the optical density of the contours and to evaluate the optimum and minimum photon fluence to be used in the tomographic system in order to reduce the absorbed doses in the individuals. This study allowed to determine the optimal fluence to validate it with realistic fluences used in the tomographic prototype ClearPET /XPAD-CT and to make an intercomparison with the absorbed doses measured with detectors located in the tomographic center.

Tendencias en el manejo de la litiasis urinaria en América Latina, España y Portugal: resultados de una encuesta en la Confederación Americana de Urología (CAU) / Trends in the management of urolithiasis in Latin America, Spain and Portugal: results of a survey in the Confederación Americana de Urología (CAU)

Objetivo: Describir las tendencias en el manejo actual de la litiasis urinaria en el entorno de la Confederación Americana de Urología (CAU) para reconocer patrones de práctica clínica e identificar necesidades educativas. Material y método: Encuesta en línea compuesta por 31 preguntas de respuesta múltiple (español y portugués) a través www.caunet.org revelando datos demográficos, patrones de práctica clínica y actitudes ante situaciones clínicas específicas. Resultados: Cuatrocientos sesenta y tres profesionales procedentes de Brasil, México, Argentina, España, Colombia, Chile y otros (3,96% de la membresía CAU) completaron la encuesta. Todos los participantes practican algún tipo de tratamiento para la litiasis urinaria: 98,5% ureteroscopia (URS) semirrígida, 83,8% nefrolitotomía percutánea (NLP), 78,2% URS flexible y 67,2% litotricia extracorpórea. Los médicos más jóvenes tienden a realizar NLP (p < 0,001) y la proporción de usuarios de URS flexible es mayor en los países de habla portuguesa (p = 0,037). La fuente de energía principal empleada es el láser (60,7%). Practican NLP de calibre reducido 15,3%, más en hospitales universitarios (p < 0,01) y profesionales de mayor edad (p < 0,01). Solo el 3,2% utiliza acceso percutáneo al riñón guiado exclusivamente por ultrasonido (US), especialmente profesionales mayores (p<0,001). Utiliza posición supina el 40,4%, más en España (p < 0,001) y en entorno universitario (p = 0,017). Practican NLP sin nefrostomía el 3,9%. En URS flexible el 19,2% no usa vaina de acceso ureteral y los profesionales de mayor edad prefieren vainas de calibre más delgado (p < 0,001). Conclusiones: El manejo de litiasis en el entorno CAU sigue un perfil similar al reconocido en las guías clínicas europea y americana, aunque se reconocen interesantes variaciones en función de la edad y de las preferencias de los profesionales. Se identifican como posibles áreas de mejora NLP de calibre reducido y punción guiada por US

Objective: To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. Material and method: An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. Results: A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P < .001), and the proportion of users of flexible URS was greater in the Portuguese countries (P = .037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P < .01) and by older practitioners (P < .01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P < .001). The supine position was used by 40.4% of the respondents, more often in Spain (P < .001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P < .001). Conclusions: The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture

Assessment of the effectiveness of attenuation of Pb aprons by using TLD dosimetry and Monte Carlo calculations.

We developed an experimental set-up by using a continuous emission X-ray (Pantak DXT-3000) and three types of Pb aprons, with thicknesses of 0.25, 0.5, and 0.75mm, coated with Mylar fiber on their surface. Aprons were placed at a distance of 2.5m from the focus. Aluminum filtration was performed at the beam output to reproduce the qualities of narrow beams, N40 (Eeffective =33keV), N80 (Eeffective =65keV), and N100 (Eeffective =83keV), according to the ISO standard 4037 (1-3). Each apron was fixed with 10 thermoluminescent dosimeters (TLDs) over its surface, five dosimeters before and five dosimeters after irradiation with X-rays. Dosimeter readings were noted, and the attenuation coefficients for each effective energy were calculated. To confirm the method of effective energy of ISO-4037 and evaluate the effectiveness of aprons according to the energy range required for different medical practices, a Monte Carlo simulation using GEANT4 code was performed. Thus, the fluence and the absorbed dose in each of the dosimeters were determined, and then the coefficients of linear attenuation were calculated and compared with the experimental data and with those reported by the National Institute of Standards and Technology. Results were consistent between theoretical calculations and experimental measures. This work will serve to make assessments for other personalized radiation protectors made of Pb.

Trends in the management of urolithiasis in Latin America, Spain and Portugal: results of a survey in the Confederación Americana de Urología (CAU). / Tendencias en el manejo de la litiasis urinaria en América Latina, España y Portugal: resultados de una encuesta en la Confederación Americana de Urología (CAU).

OBJECTIVE: To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. MATERIAL AND METHOD: An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. RESULTS: A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P<.001), and the proportion of users of flexible URS was greater in the Portuguese countries (P=.037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P<.01) and by older practitioners (P<.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P<.001). The supine position was used by 40.4% of the respondents, more often in Spain (P<.001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P<.001). CONCLUSIONS: The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture.

Encuesta sobre la formación de postgrado en la Confederación Americana de Urología: opiniones y realidades / Survey on graduate education in the Confederación Americana de Urología: Opinions and reality

Objetivo: La formación médica en el postgrado de calidad es una preocupación en la Confederación Americana de Urología (CAU), tercera sociedad urológica mundial. Es importante analizar la diversidad en los programas estatales de formación y la viabilidad e implicaciones de llevar a cabo un programa CAU común. Materiales y métodos: Se ha distribuido a directivos de sociedades nacionales que componen la CAU un cuestionario de 20 preguntas directas sobre la formación de postgrado urológica en su entorno. Resultados: Un total de 28 presidentes y expresidentes respondieron representando a 21 países, el total de los estados independientes que componen la confederación. En este escenario 664 residentes inician su programa de formación cada año, en un territorio que atiende 645,4 millones de habitantes, con una fuerza profesional activa de 16.752 especialistas. Se presentan datos acerca de la realidad formativa (duración de programas, troncalidad) y laboral (acceso laboral, posible flujo entre países), y sobre cómo se lleva a cabo la acreditación y recertificación de especialistas en estos países. Se presentan también las opiniones acerca de la viabilidad de una titulación conjunta CAU, así como algunas de sus implicaciones. Conclusiones: La formación de postgrado actual en el entorno de la CAU es heterogénea en sus programas, así como en los modos de acreditación y de recertificación. Existe un importante deseo de alcanzar una titulación conjunta, salvo en España y Portugal. Para habilitar una certificación conjunta será necesario intervenir en múltiples aspectos y niveles, redefinir los deseos de cobertura sanitaria en cada país y considerar el posible flujo de especialistas

Objective: Quality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyse the diversity in the state training programmes and the feasibility and implications of conducting a common CAU programme. Material and methods: A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. Results: A total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training programme every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the programme, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. Conclusions: The actual graduate training in the CAU setting is heterogeneous in its programmes and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists

Survey on graduate education in the Confederación Americana de Urología: Opinions and reality. / Encuesta sobre la formación de postgrado en la Confederación Americana de Urología: opiniones y realidades.

OBJECTIVE: Quality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyse the diversity in the state training programmes and the feasibility and implications of conducting a common CAU programme. MATERIAL AND METHODS: A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. RESULTS: A total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training programme every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the programme, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. CONCLUSIONS: The actual graduate training in the CAU setting is heterogeneous in its programmes and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists.

Resultados de pentafecta en prostatectomía radical robótica: primeros 100 casos en un hospital público latinoamericano / Pentafecta outcomes after robot-assisted laparoscopic radical prostatectomy: First 100 cases in Latinoamerican Hospital

Objetivo: La prostatectomía radical (PR) es el tratamiento de elección para el control del cáncer de próstata a largo plazo. El auge de la cirugía mínimamente invasiva y las nuevas tecnologías ha permitido obtener mejores resultados y aspirar a objetivos más ambiciosos. Los principales trabajos aún emplean la trifecta como forma clásica de presentación, pero esta no abarca todos los aspectos relacionados con la cirugía. La pentafecta es una nueva y amplia metodología; en ella se incluyen las complicaciones y el estado de los márgenes quirúrgicos junto con los 3 parámetros reportados clásicamente. El propósito de este estudio es reportar nuestra experiencia en prostatectomía radical laparoscópica asistida por robot (PRLAR) aplicando el concepto de pentafecta. Material y método: Describir la experiencia de esta institución entre Marzo 2009-Diciembre 2012 de PRLAR en función de pentafecta. Resultados: Se realizaron 101 intervenciones, edad promedio: 60,89±7,32 años (40-77), PSA total 8,5 ± 5,57ng/dl (0,2-29), clasificación D'Amico: bajo 29 (28,71%), intermedio 65 (64,36%), alto 7 (6,93%), tiempo operatorio 253,44 ± 51,51min (90-540), complicaciones 12,9% (Clavien I-II 10,89% y Clavien IIIa 1,98%). Márgenes quirúrgicos positivos 20,83%, recurrencia bioquímica 12,5% en seguimiento (6-44 meses), continencia y potencia 87,5% y 59,52% respectivamente al año. Conclusiones: La PRLAR es un procedimiento seguro, reproducible, con buenos resultados en función de pentafecta, inclusive durante la experiencia inicial en centros con limitada afluencia de pacientes con cáncer de próstata. Se requiere más tiempo de seguimiento y experiencia con mayor número de casos para mejorar los resultados y hacerlos comparables con los centros de excelencia

Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and to pursue more ambitious. The main works still use the trifecta how classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology for report outcomes after RP, include complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. Material and Method: Describe the experience in this institution from March 2009 to December 2012 of RALRP according pentafecta. Results: We performed 101 interventions. Average age 60,89 ± 7,32 years (40-77), total PSA 8,5 ± 5,57ng/dl (0,2-29). D'Amico classification: Low 29 (28,71%), Medium 65 (64,36%), High 7 (6,93%). Operative time 253,44 ± 51,51 minutes (90-540), Complications 12,9% (Clavien I-II 10,89% y Clavien IIIa 1,98%). Positive surgical margins 20,83%. Biochemistry recurrens 12,5% follow-up (6-44 months). Continence 87,5% per year and Potency 59,52%. Conclusions: RALRP is a safe and reproducible procedure with excelents results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. It require more time to study and experience with more patient volumen to obtain better results and data to be compared with excellence centers

Pentafecta outcomes after robot-assisted laparoscopic radical prostatectomy: first 100 cases in Latinoamerican Hospital.

OBJECTIVE: Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. MATERIAL AND METHOD: Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta. RESULTS: We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%. CONCLUSIONS: RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers.

El impacto de la cirugía robótica en Urología / The Impact of Robotic Surgery in Urology

Introducción: Hace más de una década la cirugía robótica llego a la Urología. Desde entonces, la comunidad urológica comenzó a observar la cirugía desde un ángulo diferente. Los cambios son evidentes en el presente, el futuro y la forma en que vemos nuestra pasada experiencia quirúrgica. Métodos: Se revisó la literatura médica publicada entre el año 2000 y el 2011 usando la base de datos de la National Library of Medicine y las siguientes palabras clave: cirugía robótica, asistencia robótica en cirugía, prostatectomía radical. Se hizo énfasis en el impacto de la cirugía robótica en Urología. Analizamos además las series más representativas (curva de aprendizaje finalizada) en cada uno de los abordajes robóticos en referencia a la morbilidad perioperatoria y los resultados oncológicos. Resultados: Este artículo analiza el impacto de la robótica en Urología a partir de las aplicaciones quirúrgicas y no quirúrgicas previas, la forma en que se introdujo a la Urología, sus primeros pasos, la situación actual y las expectativas futuras. Al narrar este viaje hemos intentado resaltar las modificaciones importantes que ayudaron a la cirugía robótica a recorrer su camino hasta su posición actual. Se hace énfasis también en los importantes cambios que trajo la cirugía robótica al campo del entrenamiento quirúrgico y sus consecuencias en su curva de aprendizaje. Conclusión: Los principios básicos de la cirugía aún se ponen en práctica en la cirugía robótica: la experiencia del cirujano y la prolongada práctica dan conocimiento y habilidades. Siguiendo esto, las ventajas potenciales provenientes de la tecnología pueden ser bien explotadas y verse reflejadas en mejores resultados para los pacientes (AU)

Introduction: More than a decade ago, robotic surgery was introduced into urology. Since then, the urological community started to look at surgery from a different angle. The present, the future hopes, and the way we looked at our past experience have all changed. Methods: Between 2000 and 2011, the published literature was reviewed using the National Library of Medicine database and the following key words: robotic surgery, robot-assisted, and radical prostatectomy. Special emphasis was given to the impact of the robotic surgery in urology. We analyzed the most representative series (finished learning curve) in each one of the robotic approaches regarding perioperative morbidity and oncological outcomes. Results: This article looks into the impact of robotics in urology, starting from its background applications before urology, the way it was introduced into urology, its first steps, current status, and future expectations. By narrating this journey, we tried to highlight important modifications that helped robotic surgery make its way to its position today. We looked as well into the dramatic changes that robotic surgery introduced to the field of surgical training and its consequence on its learning curve. Conclusion: Basic surgical principles still apply in Robotics: experience counts, and prolonged practice provides knowledge and skills. In this way, the potential advantages delivered by technology will be better exploited, and this will be reflected in better outcomes for patients (AU)

The impact of robotic surgery in urology.

INTRODUCTION: More than a decade ago, robotic surgery was introduced into urology. Since then, the urological community started to look at surgery from a different angle. The present, the future hopes, and the way we looked at our past experience have all changed. METHODS: Between 2000 and 2011, the published literature was reviewed using the National Library of Medicine database and the following key words: robotic surgery, robot-assisted, and radical prostatectomy. Special emphasis was given to the impact of the robotic surgery in urology. We analyzed the most representative series (finished learning curve) in each one of the robotic approaches regarding perioperative morbidity and oncological outcomes. RESULTS: This article looks into the impact of robotics in urology, starting from its background applications before urology, the way it was introduced into urology, its first steps, current status, and future expectations. By narrating this journey, we tried to highlight important modifications that helped robotic surgery make its way to its position today. We looked as well into the dramatic changes that robotic surgery introduced to the field of surgical training and its consequence on its learning curve. CONCLUSION: Basic surgical principles still apply in Robotics: experience counts, and prolonged practice provides knowledge and skills. In this way, the potential advantages delivered by technology will be better exploited, and this will be reflected in better outcomes for patients.

Enanismo tanatofórico: presentación de un caso / Thanatophoric dwarfism: a case report

El enanismo o displasia tanatofórica constituye una malformación rara del sistema esquelético que raras veces supera la etapa prenatal. Aunque se puede presentar clínicamente de dos formas diferentes, algunas alteraciones como las costillas cortas y horizontalizadas, las deformidades del tórax y los fémures cortos y encorvados son coincidentes. Se presenta un caso diagnosticado en el Centro Municipal de Genética de la Isla de la Juventud (Cuba) en el año 2010, durante la etapa prenatal y previo asesoramiento genético a los padres, se procedió a interrumpir el embarazo. Los patólogos confirmaron el diagnóstico (AU)

Thanatophoric dwarfism or dysplasia constitutes a rare malformation of the skeletal system that usually causes prenatal demise. Although there are two clinical forms, some alterations such as short and horizontal ribs, deformities of the thorax and short, curved femurs usually occur together. We describe a case of thanatophoric dwarfism prenatally diagnosed in the Municipal Center of Genetics of the Isle of Youth (Cuba). The parents were given genetic counselling and decided to interrupt the pregnancy. The diagnosis was confirmed by pathological analysis (AU)

Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot / Bidirectional Barbed Suture for Bladder Neck Reconstruction, Posterior Reconstruction and Vesicourethral Anastomosis During Robot Assisted Radical Prostatectomy

Antecedentes: La anastomosis uretrovesical es un paso exigente de la prostatectomía radical asistida por robot (PRAR). La imposibilidad de lograr una anastomosis hermética se asocia con la pérdida urinaria postoperatoria y sus consecuencias, que incluyen el íleo paralítico, la cateterización prolongada, la peritonitis urinaria y posiblemente la reintervención. La sutura barbada bidireccional es una tecnología nueva que puede llegar a mejorar la calidad de la anastomosis uretrovesical. Objetivo: Presentar nuestra técnica quirúrgica de la anastomosis uretrovesical, la reconstrucción del cuello vesical y la reconstrucción posterior utilizando una sutura barbada bidireccional. Materiales y métodos: La reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral se realizaron con una sutura barbada monofilamento bidireccional absorbible sintético 2-0. Resultados: Todos los casos se completaron con éxito, sin complicaciones graves o conversiones a cirugía laparoscópica o abierta. Conclusión: Los autores cambiamos con éxito la técnica PRAR para aprovechar las propiedades de la sutura barbada bidireccional. Estudios comparativos que evalúen los resultados objetivos, como el índice de pérdida y el tiempo de la operación, son necesarios para establecer definitivamente los beneficios de este dispositivo en comparación con el monofilamento absorbible tradicional (AU)

Background: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. Objective: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. Material and methods: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture. Results: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. Conclusion: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leak age rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament (AU)

[Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy]. / Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot.

BACKGROUND: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. OBJECTIVE: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. MATERIAL AND METHODS: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture RESULTS: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. CONCLUSION: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.

Cirugía robótica: Historia e impacto en la enseñanza / Robotic Surgery: History and Teaching Impact

Contexto: El objetivo de este artículo es hacer una revisión de la Historia de la cirugía robótica, su impacto en la enseñanza, así como una descripción de los robots antiguos y actuales usados en el campo médico. Resumen de evidencia: Aunque la historia de la robótica tiene 2.000 años o más, las últimas dos décadas han mostrado una marcada revolución en Medicina, debido a todos los cambios que la cirugía robótica ha provocado en la manera de hacer, enseñar y practicar cirugía. Conclusiones: La cirugía robótica ha evolucionado hasta ser un campo aparte, con un enorme potencial para su futuro desarrollo. Los resultados muestran hasta ahora que esta tecnología es capaz de ofrecer buenos resultados y un adecuado tratamiento a los pacientes (AU)

Context: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. Summary of evidence: Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. Conclusions: Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients (AU)

[Robotic surgery: history and teaching impact]. / Cirugía robótica: Historia e impacto en la enseñanza.

CONTEXT: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. SUMMARY OF EVIDENCE: Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. CONCLUSIONS: Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients.

[Demographic distribution and prevalence of overactive bladder in Venezuela]. / Distribución demográfica y prevalencia de la vejiga hiperactiva en Venezuela.

OBJECTIVE: There is a lack of information regarding overactive bladder (OAB) in South America. Our aim in this study was to estimate the prevalence of overactive bladder (OAB) in Venezuela based on the 2002 International Continence Society (ICS) consensus criteria and also to verify its demographic distribution in this country. SUBJECTS AND METHODS: We performed a multicentric prospective evaluation of patients from 2003 to 2007 in different cities in Venezuela. A number 3.407 adults (M:38%, F:62%) between 18 and 75 years of age (mean age 54 years) completed a physician guided questionnaire (V8) of urinary symptoms, bladder function, diet, general habits and general medical condition. Statistical procedures were carried out using software based on R programming for computational statistics. RESULTS: The overall prevalence of OAB in Venezuela was determined as 21%. Female were more affected as compared to male (25.6% vs. 13.7% in men, p < 0.005) OAB was detected at early age (18 yrs) maintaining higher prevalence in women (M: 9%, F: 14%). In the studied cohort OAB shows its highest prevalence between the subgroup of 65 to 69 years of age. In all statistical tests the level of significance was defined as p < 0.005, with a confidence interval of 95%. CONCLUSION: The OAB-V8 questionnaire aids to clearly identify patients with OAB symptoms. The overall prevalence of OAB in Venezuela is 21%. It is present in both genders, predominantly women and can be detected at early age.

Distribución demográfica y prevalencia de la vejiga hiperactiva en Venezuela / Demographic distribution and prevalence of overactive bladder in Venezuela

Objetivo: existe escasa información sobre la vejiga hiperactiva (VH) en Suramérica. El objetivo de este estudio era calcular la prevalencia de la vejiga hiperactiva en Venezuela basándonos en los criterios de consenso de la International Continence Society (ICS) de 2002 y comprobar su distribución demográfica en el país. Sujetos y métodos: desde 2003 a 2007 realizamos una evaluación prospectiva multicéntrica de pacientes en distintas ciudades de Venezuela. Un total de 3.407 adultos (38% varones y 62% mujeres) de 18 a 75 años de edad (media: 54 años) contestaron un cuestionario guiado por un médico (OAB-V8) sobre síntomas urinarios, función vesical, dieta, hábitos generales y estado médico general. Los procedimientos estadísticos se realizaron mediante software basado en programación R para estadística computacional. Resultados: se determinó una prevalencia global de la VH en Venezuela del 21%. Las mujeres estaban más afectadas que los varones (25,6 frente a 13,7% en varones, p < 0,005). LaVH se detectó a edad temprana (18 años) y mantuvo una mayor prevalencia en las mujeres (varones 9% y mujeres 14%). En la cohorte estudiada la mayor prevalencia de VH se dio en el subgrupo de 65 a 69 años de edad. En todas las pruebas estadísticas se consideró significativo un valor de p < 0,005, con un intervalo de confianza del 95%.Conclusión: el cuestionario OAB-V8 ayuda a identificar claramente a los pacientes con síntomas de VH. La prevalencia global de la VH en Venezuela es del 21%. Está presente en ambos sexos, pero sobre todo en las mujeres y puede detectarse a una edad temprana (AU)

Objective: There is a lack of information regarding overactive bladder (OAB) in South America. Our aim in this study was to estimate the prevalence of overactive bladder (OAB) in Venezuela based on the 2002 International Continence Society (ICS) consensus criteria and also to verify its demographic distribution in this country. Subjects and methods: We performed a multicentric prospective evaluation of patients from2003 to 2007 in different cities in Venezuela. A number 3.407 adults (M:38%, F:62%) between 18 and 75 years of age (mean age 54 years) completed a physician guided questionnaire(V8) of urinary symptoms, bladder function, diet, general habits and general medical condition. Statistical procedures were carried out using software based on R programming for computational statistics. Results: The overall prevalence of OAB in Venezuela was determined as 21%. Female were more affected as compared to male (25.6% vs. 13.7% in men, p < 0.005) OAB was detected at early age (18 yrs) maintaining higher prevalence in women (M: 9%, F: 14%). In the studied cohort OAB shows its highest prevalence between the subgroup of 65 to 69 years of age. In all statistical tests the level of significance was defined as p < 0.005, with a confidence interval of 95%.Conclusion: The OAB-V8 questionnaire aids to clearly identify patients with OAB symptoms. The overall prevalence of OAB in Venezuela is 21%. It is present in both genders, predominantly women and can be detected at early age (AU)

Long-term continuous treatment with sildenafil ameliorates aging-related erectile dysfunction and the underlying corporal fibrosis in the rat.

Aging-related erectile dysfunction is characterized by a loss of smooth muscle cells (SMCs) and fibrosis in the corpora cavernosa, and functionally by corporal veno-occlusive dysfunction (CVOD). Phosphodiesterase 5 (PDE5A) inhibitors, in part via upregulating inducible nitric oxide synthase (NOS2A), have antifibrotic properties in penile tissues. We aimed to determine whether in the aged rat the chronic long-term treatment with sildenafil ameliorates corporal SMC loss and fibrosis, stimulates NOS2A induction, and corrects the associated CVOD. Aged male rats (20 mo old) received sildenafil in their drinking water (20 mg/kg per day) or plain water for 45 days, and untreated young rats (5 mo old) served as controls (n = 8 per group). CVOD was assessed by dynamic infusion cavernosometry (DIC). Collagen:SMC (Masson trichrome) and collagen III:I (picrosirius red) ratios, SMC content (alpha-smooth muscle actin [ACTA2]), cell proliferation (proliferating nuclear antigen [PCNA]), apoptotic death (TUNEL), and NOS2A induction were measured by histochemistry and immunohistochemistry followed by quantitative image analysis. Collagen content was determined by hydroxyproline assay, and transforming growth factor beta-1 (TGFB1); xanthine oxidoreductase (XDH); ACTA2; NOS2A; and the Rho kinase inhibitor protein tyrosine phosphatase, nonreceptor type 11 (PTPN11), and activator, VAV, were measured by quantitative Western blot. In the aged rats treated with sildenafil, the erectile response by DIC was normalized, and the corporal SMC:collagen ratio and SMC number were increased. In addition, sildenafil reduced the corporal collagen content without affecting the collagen III:I ratio, increased the PCNA:apoptosis ratio, and stimulated NOS2A induction, although there was no effect on XDH, TGFB1, PTPN11, or VAV levels. These data show that long-term PDE5A treatment corrected CVOD in the aged rat and partially reversed the aging-related fibrosis and loss of SMC in the corpora cavernosa without affecting TGFB1 or PTPN11 levels, which are markers of oxidative stress. It may be speculated that similar effects may be achieved with this paradigm in men.