Phosphodiesterase-5 Expression in Buccal Mucosa of Patients with Erectile Dysfunction One Year after Radical Prostatectomy.

(1) Background: Radical prostatectomy has a high incidence of erectile dysfunction (ED). The aim was to determine if the expression of the nitric oxide synthase-3/soluble guanylate cyclase/phosphodiesterase 5 axis could be detected in buccal mucosa and if it could be differently expressed in patients with and without ED; (2) Methods: Erectile function from 38 subjects subjected to prostatectomy was evaluated using the International Index of Erectile Function-Erectile Function Domain before and one year after surgery. Nitric oxide synthase (NOS3), ß1-subunit of soluble guanylate cyclase (sGC), phosphodiesterase-5 (PDE-5) expressions, and interleukin-6 and interleukin-10 content were measured in the buccal mucosa. PDE5A rs3806808 gene polymorphism was genotyped; (3) Results: One year after prostatectomy, 15 patients had recovered functional erection, and 23 showed ED. NOS3, ß1-sGC, interleukin-6, and interleukin-10 expressions were not different between patients with and without ED after radical prostatectomy. Buccal mucosa levels of PDE-5 were higher in patients with ED compared to those who recovered erectile functionality. There were no differences found in the genotype of PDE5A polymorphism; (4) Conclusions: One year after prostatectomy, patients with ED had higher PDE5 levels in their buccal mucosa than patients who had recovered erectile function. Rs3806808 PDE5A gene polymorphism was not associated with increased PDE5 expression in buccal mucosa.

Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment.

Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.

Extracción renal. Situación actual / Kidney extraction. Current situation

El trasplante renal (TR) es el mejor tratamiento para la enfermedad renal crónica terminal. EnEspaña no se dispone de suficientes órganos para suplirla demanda de pacientes en lista de espera a pesar deser uno de los países líderes en donación. La supervivencia del injerto depende de la calidad delórgano, el daño que sufre durante el proceso de donación y trasplante, así como de la posibilidad de que seproduzca rechazo. Entre los factores que debemos minimizar y optimizar se encuentran las lesiones inducidaspor los mecanismos de isquemia-reperfusión, en los momentos que rodean la muerte del donante, la extraccióny la preservación del órgano hasta su trasplante.Tradicionalmente la preservación del órgano hasta elmomento del implante se ha llevado a cabo mediante laconservación en frío, ya que es una técnica con amplia disponibilidad y bajo coste. El uso de máquinas de perfusión en donaciones en asistolia y criterio expandido,ha demostrado mejores resultados a corto plazo (falloprimario, inicio retrasado de función) sin afectar a lasupervivencia del receptor o del injerto. El objetivo de este trabajo es revisar la situación actual,así como los recursos disponibles para aumentar el poolde órganos trasplantables y la calidad de estos. Hemosrealizado una revisión sobre la extracción renal, manejodel donante, métodos y técnicas de preservación paraoptimizar la donación renal de donante cadáver.(AU)

Kidney transplantation (KT) is the besttreatment for end-stage renal disease. Despite Spain isone of the leading countries in donation, the need fortransplantable organs exceeds the available supply. Graft survival depends on the quality of the organ, thedamage it suffers during the donation and transplantation process, as well as the risk of rejection. Among the factors that must be controlled and minimized are the ischemia-reperfusion injuries that occursin the moments surrounding the death of the donor, theprocurement and the preservation of the organ until kidney transplantation.Static cold storage is the traditional method of preservation of the organ until the moment of implantation, sinceit is a technique with wide availability and low cost. Theuse of perfusion machines in DCD and expanded criteria has shown better short-term results (primary failure, delayed onset of function) without affecting recipient orgraft survival.The objective of our article is to review the current situation and the resources available to increase the pool oftransplantable organs and their quality. We conducted a systematic review on kidney extraction,donor management, preservation methods and techniques to optimize cadaveric donor kidney donation:(AU)

[Renal harvest. State of the art.] / Extracción renal. Situación actual.

Kidney transplantation (KT) is the best treatment for end-stage renal disease. Despite Spain isone of the leading countries in donation, the need for transplantable organs exceeds the available supply. Graft survival depends on the quality of the organ, the damage it suffers during the donation and transplantation process, as well as the risk of rejection. Among the factors that must be controlled and minimized are the ischemia-reperfusion injuries that occurs in the moments surrounding the death of the donor, the procurement and the preservation of the organ until kidney transplantation. Static cold storage is the traditional method of preservation of the organ until the moment of implantation, since it is a technique with wide availability and low cost. The use of perfusion machines in DCD and expanded criteria has shown better short-term results (primary failur delayed on set of function) without affecting recipient orgraft survival. The objective of our article is to review the current situationand the resources available to increase the pool of transplantable organs and their quality. We conducted a systematic review on kidney extraction, donor management, preservation methods and techniques to optimize cadaveric donor kidney donation.

El trasplante renal (TR) es el mejor tratamiento para la enfermedad renal crónica terminal. En España no se dispone de suficientes órganos para suplirla demanda de pacientes en lista de espera a pesar deser uno de los países líderes en donación. La supervivencia del injerto depende de la calidad delórgano, el daño que sufre durante el proceso de donacióny trasplante, así como de la posibilidad de que seproduzca rechazo. Entre los factores que debemos minimizar y optimizar se encuentran las lesiones inducidas por los mecanismos de isquemia-reperfusión, en los momentos que rodean la muerte del donante, la extracción y la preservación del órgano hasta su trasplante.Tradicionalmente la preservación del órgano hasta elmomento del implante se ha llevado a cabo mediante la conservación en frío, ya que es una técnica con amplia disponibilidad y bajo coste. El uso de máquinas de perfusiónen donaciones en asistolia y criterio expandido,ha demostrado mejores resultados a corto plazo (fallo primario, inicio retrasado de función) sin afectar a la supervivencia del receptor o del injerto. El objetivo de este trabajo es revisar la situación actual,así como los recursos disponibles para aumentar el poolde órganos trasplantables y la calidad de estos. Hemos realizado una revisión sobre la extracción renal, manejo del donante, métodos y técnicas de preservación para optimizar la donación renal de donante cadáver.

The urological referral process from primary health care. Reflections on referral criteria.

OBJECTIVES: The flow of patients between Primary Care (PC) and Specialized care (SC) is a common process. It carries many implications for the patient, physician and health system. In Urology, only benign prostatic hyperplasia (BPH) has referral criteria. Urinary incontinence, prostate cancer (PCa), and urological ultrasound, are in the process. The aim of this paper is to communicate, with critical analysis, the characteristics of the information recorded in the referral visit (clinical reasons / rationale) and the effectiveness for urology consultation. METHODS: Observational, descriptive and quantitative study of the referral visits made between PC/SC (Urology) in the health care area of our hospital (December 2010-September 2012). We studied: Referral Visit Database (RVD), consultation document, HORUS system, and specific referral visit survey questionnaire. RESULTS. Referral visits account for 67.89% (all first consultations), 14.79% of the total number of visits. 78% were male (mean age 53 y.o). 11.84% recorded reason for consultation (98% in referral document) with normal priority (94.67%). 34% of them were for BPH. HORUS is not exploited for the referral visit. 40% start the diagnostic process with insufficient exams. 18.1% are listed as closed process / completed. Patient satisfaction was evaluated (20%). Key points in the improvement are: improve referral visit reason for consultations, to know patient's expectations, and to develop protocols (guidelines, and/or referral criteria). CONCLUSIONS. The referral process is complex. The computer system does not include the referral reason for consultation. Institutional agreement between PC/SC Urology must be reached to ensure uniformity in the implementation and support.

El proceso de la derivación urológica desde atención primaria (AP), Reflexión sobre los criterios / No disponible

OBJETIVO: La derivación de pacientes entre la Atención Primaria (AP) y la Especializada (AE) es un proceso común. Conlleva múltiples implicaciones para el paciente, médico y sistema sanitario. En Urología, sólo la Hiperplasia Benigna de Próstata (HBP) posee criterios de derivación. La incontinencia urinaria, el cáncer de próstata (CaP), y la ecografía urológica, están en proceso. El objetivo de este trabajo es comunicar con análisis crítico, las características de la información que se registra de la consulta de derivación CD (motivos clínicos/justificación) y la eficacia que provoca para la consulta del urólogo. MÉTODO: Se realiza estudio observacional, descriptivo y cuantitativo de las CD realizados entre AP/AEUrol (Urología), en el área sanitaria de nuestro hospital (Dic2010-Sep2012). Se estudia: Base de Datos CD (BD), documento interconsulta, sistema HORUS, y CSDerUrol (cuestionario-encuesta específico). RESULTADOS: La CD supone el 67,89% (total primeras consultas), el 14,79% de total de consultas. El 78% son varones (edad media 53a). El 11,84% registra motivo de consulta (98% en documento interconsulta), con prioridad normal (94,67%). El 34% es HBP. HORUS no se explota para la CD. El 40% inicia proceso de diagnóstico, con exploraciones insuficientes. El 18,1% consta como proceso cerrado/concluido. La satisfacción del paciente se recoge (20%). Puntos clave para la mejora son: mejorar los motivos CD, conocer las expectativas del paciente, y la creación de protocolos (guías de actuación y/o criterios de derivación). CONCLUSIONES: El proceso de derivación es complejo. El sistema informático no incluyen el motivo clínico de la CD. Se deben alcanzar acuerdos institucionales AP/ AEUrol que garanticen la implementación y uniformidad a la asistencia

OBJECTIVES: The flow of patients between Primary Care (PC) and Specialized care (SC) is a common process. It carries many implications for the patient, physician and health system. In Urology, only benign prostatic hyperplasia (BPH) has referral. and urological ultrasound, are in the process. The aim of this paper is to communicate, with critical analysis, the characteristics of the information recorded in the referral visit (clinical reasons / rationale) and the effectiveness for urology consultation. METHODS: Observational, descriptive and quantitative study of the referral visits made between PC/SC (Urology) in the health care area of our hospital (December 2010-September 2012). We studied: Referral Visit Database (RVD), consultation document, HORUS system, and specific referral visit survey questionnaire. RESULTS: Referral visits account for 67.89% (all first consultations), 14.79% of the total number of visits. 78% were male (mean age 53 y.o). 11.84% recorded reason for consultation (98% in referral document) with normal priority (94.67%). 34% of them were for BPH. HORUS is not exploited for the referral visit. 40% start the diagnostic process with insufficient exams. 18.1% are listed as closed process / completed. Patient satisfaction was evaluated (20%). Key points in the improvement are: improve referral visit reason for consultations, to know patient's expectations, and to develop protocols (guidelines, and/or referral criteria). CONCLUSIONS: The referral process is complex. The computer system does not include the referral reason for consultation. Institutional agreement between PC/SC Urology must be reached to ensure uniformity in the implementation and support

Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

Adenoma nefrogénico de localización prostática. Aportación de un caso / Prostatic nephrogenic adenoma. Case report

OBJETIVO: Presentamos el caso de un adenoma nefrogénico de uretra prostática como hallazgo incidental tras una resección trasuretral de próstata.MÉTODO/RESULTADO: Se trata del diagnóstico incidental de adenoma nefrogénico de uretra prostática en varón de 50 años intervenido de hiperplasia benigna prostática mediante resección trasuretral.CONCLUSIONES: El adenoma nefrogénico es una lesión benigna del tracto urinario, infrecuente, asociado con una historia previa de traumatismo o irritación sobre el urotelio. Los factores predisponentes incluyen las infecciones, cálculos, cirugía, traumatismos y el trasplante renal(AU)

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate.METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection.CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation(AU)

Adrenal myelolipoma. Contribution of a case and bibliographic review.

OBJECTIVE: We report the case of adrenal gland myelolipoma. METHODS/RESULTS: The patient was a 29 year old who is diagnosed with an adrenal adenoma during an endocrinology review. He underwent laparoscopic adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma. CONCLUSIONS: The myelolipoma is a rare tumor composed of hematopoietic elements in different maturation stages and without histological changes, combined with mature adipose tissue in varying proportions. Most of them are incidental findings during radiologic complementary tests. Treatment should be tailored to each particular case. Surgery is indicated when the mass exceeds the size 4-6 cm or when it is a functioning mass.

Mielolipoma suprarrenal. Aportación de un caso y revisión de la literatura / Adrenal myelolipoma. Contribution of a case and bibliographic review

OBJETIVO: Presentamos el caso de un mielolipoma de localización adrenal.MÉTODO/RESULTADO: Presentamos una paciente de 29 años que es diagnosticada de un adenoma suprarrenal de 6 cm durante una revisión endocrinológica. Se le practica una suprarrenalectomía laparoscópica. El estudio patológico confirma el diagnóstico de mielolipoma suprarrenal.CONCLUSIONES: El mielolipoma es un tumor infrecuente constituido por elementos hematopoyéticos en diferentes estadios madurativos y sin alteraciones histológicas, combinados con tejido adiposo maduro en proporciones variables. La mayoría son hallazgos incidentales durante exploraciones radiológicas complementarias.La cirugía de la masa está indicada cuando la lesión sea mayor de 6 cm, funcionante y/o sintomática (AU)

OBJECTIVE: We report the case of a myelolipoma of the adrenal glands.METHOD/RESULTS: The patient is a 29 year old who is diagnosed with an adrenal adenoma during a review in endocrinology. He underwent laparoscopic adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma.CONCLUSIONS: The myelolipoma is a rare tumor composed of hematopoietic elements in different maturation stages and without histological changes, combined with mature adipose tissue in varying proportions. Most are incidental findings during radiologic complementary. Treatment should be tailored to each particular case. Surgery is indicated when the mass exceeds the size 4-6 cm or when it is functioning (AU)

Síndrome metabólico y disfunción eréctil / Metabolic síndrome and erectile dysfunction

OBJETIVO: Puesta al día de un síndrome que en los pasados años ha ido incrementando las patologías coincidentes en el mismo, tales como obesidad, hipertensión, hipercolesterolemia, diabetes tipo II, con la reciente adición de la disfunción erectil y la androgenodeficienciaMÉTODO: Revisión global de la literatura tomando como referencia las últimas aportaciones y muy especialmente las debidas al profesor M. Serrano Ríos, de Madrid, y su grupoRESULTADOS: El síndrome metabólico parece actualmente consolidado como terminó universalmente aceptado, a pesar de su complejo itinerario semántico y nosologico. La inclusión de la disfunción erectil y la androgenodeficiencia le da más solidez patogénica y aproxima más al terreno profesional de la endocrinología a dos procesos prioritariamente urológicos. El urólogo recibe a su vez una nueva perspectiva de procesos que son inexcusablemente propios y a los que ha de atender con mayor amplitud exploratoria, analítica y terapéuticaCONCLUSIÓNES: El síndrome metabólico puede ser reconocido en la consulta urológica con más frecuencia de lo sospechado. El urólogo queda obligado, en este proceso típicamente médico, a ejercer con más dedicación y amplitud el compromiso médico de su especialidad médico quirúrgica(AU)

OBJECTIVES: To update a syndrome that has increased the number of pathologies included such as obesity, hypertension, hypercholesterolemia, type II diabetes mellitus, and the recent addition of erectile dysfunction and androgen deficiencyMETHODS: Global review of bibliography taking the last articles as a reference and mainly those from Prof. M. Serrano Rios and his group in Madrid.RESULTS: Metabolic syndrome seems to be consolidated as a universally accepted term, despite its complex semantic and gnoseologic itinerary. The inclusion of erectile dysfunction and androgen deficiency gives more pathogenic solidity and makes the professional field of endocrinology closer to two mainly urological processes.The urologist has a new perspective of processes that are of his own, that he has to take care of in a comprehensive manner, with physical examination, blood tests and therapy. CONCLUSIONS: Metabolic syndrome may be more frequently than suspected recognized in the urologist office. Urologists are compelled, in this typically medical process, to exercise with more dedication and fullness the medical compromise of our medical-surgical specialty(AU)

Emphysematous pyelonephritis in dialysis patient after embolization of failed allograft.

Emphysematous pyelonephritis is an uncommon acute infection characterized by the presence of gas in the renal parenchyma. Diabetics account for most cases, and the mortality rate is high. We report a case of emphysematous pyelonephritis after therapeutic embolization of a nonfunctioning renal graft in a nondiabetic dialysis patient. Given the increasing popularity of therapeutic embolization to control graft intolerance syndrome associated with rejected kidneys, physicians should be aware of this potentially severe complication. We discuss the differential diagnosis from entities requiring different management strategies, such as postembolization syndrome, persistence of graft intolerance, and the presence of sterile intrarenal.

[Chronic prostatitis: critical review of its current nosologic definition, classification and potential carcinogenesis]. / Prostatitis crónica: una revisión crítica de su actual definición nosológica, clasificación y potencial carcinogénesis.

Updated critical review of chronic prostatitis as a nosologic, anatomic-clinical entity of supposed microbiological or inflammatory origin. Scientific reasoning about the role of amicrobial inflammation in both caudal and cranial prostate, after new progresses, to reconsider the convenience of maintaining the current classification of chronic prostatitis, mainly in the section referred to "histological prostatitis". Analysis of scientific evidences relating prostatitis and "pelvic pain", the dominant syndrome in many patients and basement of the current terminological proposal: prostatitis-pelvic pain. The role of inflammation in the genesis of BPH and prostate cancer. Justification and convenience of a new term in logic consensus on prostatitis.

Prostatitis crónica: una revisión crítica de su actual definición nosológica, clasificación y potencial carcinogénesis / Chronic prostatitis: critical review of its current nosologic definition, classification and potential carcinogenesis

Revisión crítica actualizada de la prostatitis crónica, como entidad nosológica, anatomoclínica, supuestamente de origen microbiológico o inflamatorio. Argumentación científica, a la luz de los nuevos progresos, sobre el papel de la inflamación amicrobiana, tanto a nivel de la próstata craneal como de la caudal, para reconsiderar la conveniencia de mantener la clasificación actual de las prostatitis crónicas, y especialmente el apartado referido a la «prostatitis histológica». Análisis de evidencias relacionando la prostatitis «con el dolor pélvico», síndrome dominante en muchos pacientes y fundamento de la actual propuesta terminológica; prostatitis-dolor pélvico. Papel de la inflamación en la génesis de la HBP y cáncer de próstata. Justificación y conveniencia de un nuevo consenso terminológico sobre las prostatitis, en general (AU)

Updated critical review of chronic prostatitis as a nosologic, anatomic-clinical entity of supposed microbiological or inflammatory origin. Scientific reasoning about the role of amicrobial inflammation in both caudal and cranial prostate, after new progresses, to reconsider the convenience of maintaining the current classification of chronic prostatitis, mainly in the section referred to «histological prostatitis». Analysis of scientific evidences relating prostatitis and «pelvic pain», the dominant syndrome in many patients and basement of the current terminological proposal: prostatitis-pelvic pain. The role of inflammation in the genesis of BPH and prostate cancer. Justification and convenience of a new term in logic consensus on prostatitis (AU)

The impact of medical therapy on surgery for benign prostatic hyperplasia: a study comparing changes in a decade (1992-2002).

OBJECTIVES: To compare the clinical profile (age, comorbidities, symptom severity, and incidence of acute urinary retention, AUR), the type and duration of medical treatment, and indications for surgery of patients undergoing surgery for benign prostatic hyperplasia (BPH) in 1992 and 2002 at one centre. PATIENTS AND METHODS: In this single-centre, retrospective, cross-sectional observational study, the medical history of all patients who had surgery for BPH in the first semester of 1992 (85) and 2002 (70) was reviewed. The preoperative clinical profile was determined by assessing age, main comorbidities, prostatic volume, maximum urinary flow rate and symptom severity. The type and duration of pharmacology for BPH was evaluated from the medical history and telephone contact with the patients. Indications for surgery, the method of operation and the weight of removed tissue (open adenectomy) or the volume of the resected tissue (transurethral resection) were obtained from the patients' records and compared. Surgical complications in both groups were assessed, as was the average stay in hospital. RESULTS: In our institution, surgery for BPH decreased by 17.6% in the decade, with patients having surgery when older, at a mean (sd) of 69.1 (8.57) vs 72.3 (7.59) years, i.e. 3.1 years older (P = 0.028), but with similar comorbidities. Reasons for surgery in 1992/2002, respectively, were AUR in 41/37%, and symptoms worsening in 48/51%. The few cases of haematuria and bladder stone were similarly distributed in both groups. Pharmacology for BPH was prescribed in 46% of patients in 1992, phytotherapy being the most common (89%), whereas in 2002, 82% (P < 0.01) were treated, most of them with alpha-adrenergic antagonists (79%). Open surgery was indicated in 18.8% of patients in 1992 (mean adenoma weight 73.8 g, sd 37.12) and in 28.6% in 2002 (79.8 g, sd 35.41; P = 0.625). The mean (sd) hospital stay was 8.9 (4.06) vs 5.0 (1.22) days in 1992 and 2002, respectively (P < 0.01) for transurethral resection, and 14.1 (5.74) vs 8.7 (4.83) for open adenectomy (P = 0.013). The complication rate was similar for both groups. CONCLUSIONS: Compared with 1992, fewer patients with BPH have surgery, when older and after receiving medical treatment for longer. The indications for surgery are similar. Significantly more patients had open surgery, perhaps because the progressive increase in prostate volume was not affected by the medical therapy used predominantly during this decade.

[Impotence and cardiovascular disease: a new perspective in the health-care compromise of the urologist]. / Impotencia y enfermedad cardiovascular: una nueva perspectiva en el compromiso asistencial del urólogo.

OBJECTIVES: To review the evidence currently available to establish the pathogenic connection between erectile dysfunction (ED) and cardiovascular disease (CVD), and the effects this scientific progress has introduced in the classical impotence urology clinic. METHODS: We reviewed the most recent publications about this disease (2000-2004) and the concept of endothelial dysfunction by appropriate MEDLINE searches, with specific selection of reviews and clinical practice guidelines. RESULTS: The fact that ED and CVD share risk factors is confirmed; the pathogenic unity of both processes having endothelial dysfunction as the underlying problem; anticipation of ED over CVD in time of presentation; notable increase of research about this issue over the last two years; the change of scenario in the impotence urology clinics due to these findings. CONCLUSIONS: The number of cases in which ED is not an organ disease but an early symptom of endothelial dysfunction forces changes in the extent and depth of the diagnostic, prognostic and follow-up strategies in the urology impotence clinics of extraordinary importance from both the individual and health-care politics point of view.

Impotencia y enfermedad cardiovascular: una nueva perspectiva en el compromiso asistencial del urólogo / Impotence and cardiovascular disease: a new perspective in the health-care compromise of the urologist

OBJETIVO: Revisar las evidencias aportadashasta el momento que establecen la conexiónpatogénica entre disfunción eréctil (D.E.) y enfermedadcardiovascular (E.C.V.) y los efectos que esteprogreso científico ha motivado sobre la consulta urológicatradicional por impotencia.MÉTODOS: Las publicaciones más recientes (2000-2004) sobre esta patología y el concepto de disfunciónendotelial han sido revisadas, mediante losoportunos Medlines, con selección específica de revisionesde conjunto y guías de atención médica.RESULTADOS: Se confirma que D.E. y E.C.V. compartenfactores de riesgo; la unicidad patogénica deambos procesos, teniendo la disfunción endotelialcomo problema de fondo; la precocidad de la D.E.en su presentación sobre la E.C.V.; el notable incrementode las investigaciones sobre este tema en losdos últimos años; el cambio de “escenario” en laconsulta urológica por impotencia debido a estoshallazgos CONCLUSIONES: La frecuencia con que D.E. no esuna enfermedad de órgano sino el síntoma precozde disfunción endotelial obliga a cambios en amplitudy profundidad, en la estrategia diagnóstica, pronósticay de seguimiento de la consulta urológica porimpotencia, de extraordinaria importancia individualy sanitaria

OBJECTIVES: To review the evidencecurrently available to establish the pathogenic connectionbetween erectile dysfunction (ED) and cardiovasculardisease (CVD), and the effects this scientific progresshas introduced in the classical impotence urology clinic.METHODS: We reviewed the most recent publicationsabout this disease (2000-2004) and the concept ofendothelial dysfunction by appropriate MEDLINEsearches, with specific selection of reviews and clinicalpractice guidelines.RESULTS: The fact that ED and CVD share risk factors isconfirmed; the pathogenic unity of both processeshaving endothelial dysfunction as the underlying problem;anticipation of ED over CVD in time of presentation;notable increase of research about this issue over thelast two years; the change of scenario in the impotenceurology clinics due to these findings.CONCLUSIONS: The number of cases in which ED isnot an organ disease but an early symptom of endothelialdysfunction forces changes in the extent and depth ofthe diagnostic, prognostic and follow-up strategies inthe urology impotence clinics of extraordinary importancefrom both the individual and health-care politics point ofview

Serenoa repens treatment modifies bax/bcl-2 index expression and caspase-3 activity in prostatic tissue from patients with benign prostatic hyperplasia.

PURPOSE: Permixon is a lipidosterolic extract of Serenoa repens (SR) widely used to treat men with benign prostatic hyperplasia (BPH). We tested the effect of this drug on molecular mechanisms associated with apoptosis, such as the Bax-to-Bcl-2 expression ratio and caspase-3 activity, in prostatic tissue from men with symptomatic BPH treated for 3 months before surgery. MATERIALS AND METHODS: An open, multicenter pilot study of 2 parallel groups of patients with BPH was done. They were randomized to be followed for 3 weeks without any treatment before surgery (control group) or to receive 160 mg SR orally twice daily for a 3-month period preceding the same surgery. Surgery was ultimately performed in 17 controls and 12 patients by transurethral prostate resection or retropubic adenomectomy. Bax and Bcl-2 expression, and caspase-3 activity were determined by Western blot in 15 controls and 10 patients, and reported in blinded fashion. RESULTS: The Bax-to-Bcl-2 ratio, which is used as an apoptotic index, was significantly increased in the prostatic tissue of treated patients. The level of the intact 116 kDa poly (adenosine diphosphate-ribose) polymerase form, an enzyme involved in the cell death apoptotic pathway, was also found to be decreased in prostatic tissue from SR treated patients, suggesting increased caspase 3 activity in the prostate. CONCLUSIONS: Permixon increased molecular markers involved in the apoptotic process, ie the Bax-to-Bcl-2 expression ratio and caspase-3 activity. This could have clinical relevance due to the improvement in symptoms produced by treatment with this drug.

[Current indications of percutaneous nephrostomy associated with extracorporeal shock wave lithotripsy in the treatment of renoureteral stones]. / Indicaciones actuales de la nefrostomía percutanea asociada a la litotricia extracorpórea por ondas de choque en el tratamiento de la litiasis reno ureteral.

OBJECTIVES: To evaluate the usefulness of PN as urinary diversion in the treatment of urinary stones by ESWL. METHODS: Between April 1996 and June 2003 9554 ESWL were performed at the lithiasis unit of the Fundación Jiménez Diaz; 0.91% required previous insertion of a PN. We performed a retrospective analysis of the 49 patients with the diagnosis of upper urinary tract stones who require treatment by ESWL associated with PN. Indications for PN were: ureteral obstruction by fragments 6%, treatment of residual stones after percutaneous nephrolithectomy 6%, ureteral obstruction by a calcified double J stent 5%, urinary sepsis 75%, and obstructive anuria in a solitary kidney 8%. RESULTS: Overall, 87 sessions were performed in 49 patients. Number of shock waves 3996, Kv 7.69. Results where comparable in terms of stone size and composition. 57% of the patients were stone-free after one session, 24% after 2, and 19% required more than 2 sessions. There were two failures requiring surgery. CONCLUSIONS: Although in-situ ESWL is the treatment of choice for renoureteral lithiasis, the PN is a complementary procedure when ureteral obstruction requires treatment; it is non invasive and may be successfully associated to ESWL.

[Benign prostatic hyperplasia: five year follow-up in patients who underwent contact laser vaporization]. / HBP: seguimiento a cinco años de los pacientes tratados mediante vaporización por láser de contacto.

OBJECTIVES: To determine the long-term efficacy and complications of contact laser prostatectomy in the treatment of the benign prostatic hyperplasia (BPH). METHODS: 32 patients in a prospective clinical trial of contact laser prostatectomy were followed for 5 years. Patients were assessed by physical examination, International Prostate Symptom Score (IPSS), uroflowmetry, post void residual urine, transrectal ultrasound and PSA. RESULTS: From the initial cohort, three patients had died from concomitant diseases. Three patients (9%) had undergone reoperation (TURP). Seven Patients (22%) received alpha blockers for irritative symptoms. IPSS and maximum flow improved significantly and remained stable at five years. There were not statistically significant differences in prostate volume or PSA level. CONCLUSIONS: Contact laser prostatectomy is a safe and effective treatment for BPH in the long-term. It has minimal morbidity and durable therapeutic effects. Nevertheless, in our experience postoperative irritative voiding symptoms (22%) are the major disadvantage.