[Diode laser enucleation of the prostate (Dilep): technique and initial results]. / Enucleación prostática con láser de diodo (Dilep): técnica y resultados iniciales.

INTRODUCTION: we present our preliminary experience and results of practising the prostate enucleation technique using a diode laser (DiLEP) and intravesical morcellation, following the same principles of holmium laser enucleation (HoLEP). MATERIALS AND METHOD: we endoscopically treated benign prostate hyperplasia with DiLEP in 17 patients over a period of five months. They were all followed up for three months with flowmetry and IPSS. We have described the prostate enucleation and morcellation technique in detail, as well as the materials required to perform them. We have also commented on the lessons learned having practised on more than 300 cases with HoLEP, with a view to applying this new technology. RESULTS: the mean age was 74.2 and the mean prostate volume was 61.26 (47-110) cc. The mean loss of haemoglobin was 2.1 (1.4-3.1) gr/dl. There were no major consequences or complications. All the patients were discharged from the hospital 24 hours after the operation. The improvement in the IPSS (22.3±4.1 vs. 7.1±1.06) and in the Q max (7.14±2.6 vs. 21.4±3.6) was sustainable. CONCLUSIONS: It is the first description of the DiLEP technique for the surgical treatment of benign prostate hyperplasia. We believe the results obtained are promising and that they could signify some advantages as opposed to HoLEP. However, prospective randomized studies are required to confirm this opinion.

Enucleación prostática con láser de diodo (Dilep): técnica y resultados iniciales / Diode laser enucleation of the prostate (Dilep): technique and initial results

Introducción: se presenta la experiencia preliminar y resultados de practicar la técnica de enucleación prostática mediante láser diodo (Dilep) y morcelación intravesical, siguiendo los mismos principios de la enucleación con láser de Holmio (Holep). Material y método: a lo largo de 5 meses se ha llevado a cabo el tratamiento endoscópico de la hiperplasia benigna de próstata mediante Dilep en 17 pacientes. Todos ellos han sido seguidos tres meses con flujometría e IPSS. Se describe con detalle la técnica de enucleación prostática y de morcelación, así como el material necesario para llevarla a cabo. Se comentan también las enseñanzas aprendidas con la práctica de más de 300 casos con Holep, de cara a la aplicación de esta nueva tecnología. Resultados: la edad media fue 74,2 años y el volumen prostático medio 61,26 (47-110) cc. La pérdida media de hemoglobina fue 2,1 (1,4-3,1) g/dl. No sucedieron secuelas ni complicaciones mayores. Todos los pacientes abandonaron el hospital a las 24 horas de la intervención. La mejoría en el IPSS (22,3±4,1 vs. 7,1±1,06) y en el Qmax (7,14±2,6 vs. 21,4±3,6) fue ostensible. Conclusiones: se trata de la primera descripción de la técnica Dilep para el tratamiento quirúrgico de la hiperplasia benigna de próstata. Pensamos que los resultados conseguidos son prometedores y que podría suponer algunas ventajas frente a Holep. No obstante, se necesitan estudios prospectivos aleatorizados que confirmen esta opinión (AU)

Introduction: we present our preliminary experience and results of practising the prostate enucleation technique using a diode laser (DiLEP) and intravesical morcellation, following the same principles of holmium laser enucleation (HoLEP). Materials and method: we endoscopically treated benign prostate hyperplasia with DiLEP in 17 patients over a period of five months. They were all followed up for three months with flowmetry and IPSS. We have described the prostate enucleation and morcellation technique in detail, as well as the materials required to perform them. We have also commented on the lessons learned having practised on more than 300 cases with HoLEP, with a view to applying this new technology. Results: the mean age was 74.2 and the mean prostate volume was 61.26 (47-110) cc. The mean loss of haemoglobin was 2.1 (1.4-3.1) gr/dl. There were no major consequences or complications. All the patients were discharged from the hospital 24hours after the operation. The improvement in the IPSS (22.3±4.1 vs. 7.1±1.06) and in the Q max (7.14±2.6 vs. 21.4±3.6) was sustainable. Conclusions: It is the first description of the DiLEP technique for the surgical treatment of benign prostate hyperplasia. We believe the results obtained are promising and that they could signify some advantages as opposed to HoLEP. However, prospective randomized studies are required to confirm this opinion (AU)

[Holmium laser enucleation of the prostate. Experience in Hospital Germans Trias i Pujol]. / Enucleación prostática con láser de holmio. Experiencia del Hospital Germans Trias i Pujol.

OBJECTIVES: Evaluate the introduction of the enucleation with Holmium laser in our center, including the surgeon's learning curve by the analysis of the patients. MATERIALS AND METHODS: 150 procedures have been analyzed in a retrospective manner with an average follow-up of 11 months. Qmax, IPSS and Qol have been determined before surgery, at 6 months and 12 months, realizing their statistic analysis. PSA was measured before surgery and after 3 months. Complications, surgical time and hospital stay have been analyzed. RESULTS: Average patient age was 72, 4 years. Average prostatic size was of 71,3 gr (18-150). Average hospital stay was of 22 h. Qmax before surgery, 6 months, 12 months was of 7,53 ml/s, 23,24 ml/s and 21,62 ml/s being statistically significant (p<0,01). Transfusion rate was of 1,3% and urethral stenosis rate of 4%. IPSS improvement at 6 and 12 months was statistically significant as well (p<0, 01). CONCLUSIONS: Enucleation with Holmium laser is a safe and effective technique with lower complication rate than TURP, included during the learning curve.

Sequential mitoxantrone/prednisone followed by docetaxel/estramustine in patients with hormone refractory metastatic prostate cancer: results of a phase II study.

BACKGROUND: Mitoxantrone/prednisone ameliorates symptoms in hormone refractory prostate cancer (HRPC) but has no effect on survival. Docetaxel (Taxotere)/estramustine improves response but with significant toxicity. We reasoned that a sequential administration of the two regimens could be a viable alternative for delivering full doses of chemotherapy, avoiding overlapping toxicity and preserving dose intensity. PATIENTS AND METHODS: Thirty HRPC patients were treated with mitoxantrone 10 mg/m(2), day 1, every 3 weeks, plus prednisone 5 mg twice daily, for three cycles, followed by estramustine phosphate, 280 mg three times daily, days 1 to 5, plus docetaxel 75 mg/m(2), day 2, every 3 weeks for a maximum of 10 cycles. RESULTS: All patients were assessable for response and toxicity. After mitoxantrone/prednisone treatment, the prostate-specific antigen (PSA) response rate was 23%, which increased to 63% after completion of sequential mitoxantrone/prednisone and docetaxel/estramustine treatment (12 partial and 7 complete responses). With a median follow-up of 18 months, median survival for all patients was 18 months, and median progression-free survival was 10 months. The mitoxantrone/prednisone regimen was well tolerated, and the only grade 3-4 toxicity was grade 3 neutropenia in four (13%) patients. Twenty-nine patients received a total of 173 cycles of docetaxel/estramustine (median, 6 cycles/patient). Six (20%) patients had grade 3-4 neutropenia and two (6%) patients had febrile neutropenia episodes. The most frequent non-hematological toxic effects were asthenia, nausea and vomiting, edemas and onycholysis. Two (6%) patients had deep venous thrombosis. CONCLUSIONS: Mitoxantrone/prednisone followed by docetaxel/estramustine is a well-tolerated and active regimen in HRPC. Sequential therapy is feasible and can be used to integrate novel, more active regimens.

[Current controversies on the treatment of urinary lithiasis]. / Controversias actuales en el tratamiento de la litiasis urinaria.

With the discovery during the 1960s of an access to the renal sinus and intra-operative radiological monitoring, the lithiasis surgery reached its summit of technical perfection. A comparative study on the various therapeutical options is presented: NLP, URN, ESWL and open surgery, as the single or combined treatment in complex renal lithiasis. Also, intrasinusal and transparenquimatous accesses to the intrarenal tract are compared, evaluating the morbidity, surgical time and economical interpretation of both techniques. Establishment of each treatments' indications and contraindications as well as likely short- and long-term adverse effects of the new technologies.

Experimental model for ureteral autotransplantation in the rat.

The development of an experimental model for ureteral autotransplantation without kidney transplantation, in an attempt to confirm viability of the ureter after denervation and total ischemia, is reported. Stages of the study and the experimental microsurgical technique used are discussed. Experiments were carried out in 30 Sprague-Dawley rats distributed in two experimental stages. The absence of histologic lesions was demonstrated by exeresis of the autotransplantated ureter and latter pathological study. Size, colour, renal consistency, ureteral peristalsis and the macroscopic appearance of the surgical piece were recorded. Histological examination confirmed macro- and microscopic normality of the autotransplanted ureteral segment.

Xanthogranulomatous pyelonephritis and systemic amyloidosis: report of 2 new cases and the natural history of this association.

The association of xanthogranulomatous pyelonephritis and systemic amyloidosis is extremely rare. To our knowledge, despite innumerable cases of xanthogranulomatous pyelonephritis reported in the literature, this association has been described on only 2 occasions. Clinical, analytical and radiographic findings can be highly suggestive of the diagnosis. We report on 2 patients with xanthogranulomatous pyelonephritis, systemic amyloidosis and the nephrotic syndrome: 1 died 4 1/2 years after diagnosis and 1 was stable with good general health 3 years after diagnosis. The clinical aspects as well as the treatment given to both patients are discussed. We describe the natural history of an association that due to its rarity is not currently well known.

Ureteral obstruction and ureteral fistulas after aortofemoral or aortoiliac bypass surgery.

Ureteral injury after aortofemoral or aortoiliac bypass surgery has seldom been described in the literature considering the large number of bypass operations performed. Some causative factors, such as the position of the bypass, are obvious while others are less clear. However, no attempt has been made to unify criteria to establish a management protocol. Of 154 cases of ureteral units with ectasia reviewed ureteral fistulas were present in 19. Radiological ureteral obstruction appears to precede fistula formation. Symptoms, time of diagnosis and treatment according to the predominant etiology have been discussed. Etiological (in varying degrees of importance), clinical and diagnostic criteria, together with a management and therapeutic protocol in which early and late lesions are clearly differentiated were established, while bearing in mind that not all radiological obstruction patterns correspond to true ureteral lesions.

[Ureteral lesions produced by an aortofemoral prosthesis. Apropos of a case]. / Lésions urétérales produites par une prothèse aorto-fémorale. A propos d'un cas.

Ureteral lesions following surgery to aorta are reported infrequently. Since 1966, when Lytton published an account of ureteral obstruction from a graft anterior to ureter, several series have been published. In the present case the initial problem was to consider the diagnosis, masked by a supposedly abdominal symptomatology. The second stage was analysis of results of urography and tests of the fluid collection. Effective treatment of this serious complication with preservation of infection of graft was obtained in the case reported by conservative surgery by means of ureteral anastomosis.

[Liver disease associated with hypernephroma. A case report (author's transl)]. / Hepatopatía asociada al hipernefroma. A propósito de un caso.

The observation of a non-metastatic reactive hepatopathy associated with a hypernephroma in a 39-year-old man who had had fever for 4 months led to a review of the literature and an analysis of basically three aspects of the disorder: a) The various manifestations of carcinoma of the kidney, which include a large number of paraneoplastic clinical symptoms (polycythemia, anemia, prolonged fever, hypercalcemia, hypertension, nefropathy, loss of salt, peripheral neuropathy, and amyloidosis); b) an alteracion of hepatic function known since 1961 which is characterized by an abnormal retention of sulfobromophthalein, increase of alkaline phosphatase, prothrombin decrease, dysproteinemia with hypoalbuminemia, and alpha2-globulin increase. It may or may not be accompanied by enlargement of the liver. c) Criteria of operability of the primary tumor.