[Prospective randomized study on the use of lidocaine local anesthesia in prostate biopsy]. / Estudio prospectivo randomizado sobre el uso de anestesia local con lidocaína en la biopsia prostática.

OBJECTIVES: Transrectal ultrasonography-guided prostate biopsy is still the main technique in prostate cancer diagnosis. In spite of being a relatively well-tolerated exploration, often results in an awkward and painful procedure, especially in those cases in which the number of samples increase. We designed a prospective randomized study that compares biopsies tolerance with the use of intravenous analgesia and intrarectal gel with or without intracapsular prostatic anesthesia. METHODS: We have included an amount of 80 procedures between June 2006 and December 2007. Intravenous analgesia was given to all patients and 12.5 gr. of lidocaine gel (which contains 250 mg of lidocaine hydrochloride) was instilled into the rectal vault. All patients underwent methodically 10 cores biopsy after having an intracapsular injection of 8 ml. of 2% lidocaine in a randomized group. A questionnaire with three measurements of the visual analogue scale of pain was given immediately after the procedure and another one thirty minutes later, as well as a satisfaction survey. RESULTS: The average age of patients in control group was 68 years (48-73 range) and 69 years (50-75 range) in treatment group. The average PSA was 7.1 ng/mL (4.8-9.8 range) in the first group and 7.3 ng/mL (4.5-9.7 range) in the second one. Average pain in the visual analogue scale in patients without intracapsular anesthesia was 8.3 (2 - 9)in the first questionnaire and 2 (0 - 4) in the second one, against 4 (0 - 8) and 1.33 (0-2) of the group who did receive anesthesia. If we compare both groups, we find statistically significant differences only in immediately measurements ( p<0,01) , not in the second questionnaire (p=0,2) . We didn't find statistically significant differences as for urethral bleeding, rectorrhagia or infection between both groups. CONCLUSION: We consider the injection of intracapsular lidocaine a reproductible technique and effective for both improving tolerance and diminishing the pain related to transrectal ultrasound-guided prostate biopsy without increasing morbidity.

Estudio prospectivo randomizado sobre el uso de la anestesia local con lidocaína en la biopsia prostática / Prospective randomized study on the use of lidocaine local anesthesia in prostate biopsy

OBJETIVOS: La biopsia prostática transrectal ecodirigida continúa siendo la técnica fundamental en el diagnóstico del cáncer de próstata. A pesar de ser una exploración relativamente bien tolerada, en muchas ocasiones resulta un procedimiento incómodo y doloroso, sobre todo en aquellos casos en los que se amplía el número de cilindros tomados.Presentamos un estudio prospectivo randomizado que compara la tolerancia a la biopsia con el uso de analgesia endovenosa y gel intra-rectal con y sin anestesia prostática intracapsular.MÉTODOS: Entre junio 2006 y diciembre 2007 hemos incluido un total de 80 procedimientos. En todos los pacientes se administró un analgésico endovenoso y se aplicaron 12,5 gr de gel con 250 mgr de hidrocloruro de lidocaína intra-rectal. En todos se realizó sistemáticamente la toma de 10 cilindros, previa inyección intracapsular de 8 mL de lidocaína al 2% en el grupo aleatorizado. Para ello se entregó un cuestionario con tres medidas de escala analógica visual del dolor inmediatamente tras el procedimento, y otro treinta minutos después, así como una encuesta de satisfacción.RESULTADOS: La edad media de nuestros pacientes fue de 68 años (rango 48 – 73) en el grupo que no recibió anestesia y de 69 años (rango 50 – 75) en el que sí la recibió. El PSA medio fue 7’1 ng/mL (rango 4’8 – 9’8) en el primer grupo y 7’3 ng/mL (rango 4’5 – 9’7) en el segundo. La media de dolor en la escala analógica visual en los pacientes sin anestesia intracapsular fue de 8,3 (2 – 9) en la primera encuesta y 2 (0 – 4) en la segunda, frente a 4 (0 – 8) y 1,33 (0 – 2) del grupo que sí la recibió. Al comparar ambos grupos encontramos diferencias estadísticamente significativas sólo en la valoración inmediata a la biopsia (p<0,01), no así en el segundo cuestionario (p=0,2). No encontramos diferencias estadísticamente significativas en cuanto a uretrorragia, rectorragia o infección entre ambos grupos(AU)

CONCLUSIÓN: Consideramos la inyección de lidocaína intracapsular una técnica reproducible y efectiva en cuanto a mejorar la tolerancia y disminuir el dolor asociado a la realización de biopsia prostática transrectal ecodirigida, sin incrementar la morbilidad del procedimiento(AU)

OBJECTIVES: Transrectal ultrasonogra-phy-guided prostate biopsy is still the main technique in prostate cancer diagnosis. In spite of being a relatively well-tolerated exploration, often results in an awkward and painful procedure, especially in those cases in which the number of samples increase.We designed a prospective randomized study that compares biopsies tolerance with the use of intravenous analgesia and intrarectal gel with or without intracapsu-lar prostatic anesthesia.METHODS: We have included an amount of 80 pro-cedures between June 2006 and December 2007. In-travenous analgesia was given to all patients and 12.5 gr. of lidocaine gel (which contains 250 mg of lidocai-ne hydrochloride) was instilled into the rectal vault. All patients underwent methodically 10 cores biopsy after having an intracapsular injection of 8 ml. of 2% lidocai-ne in a randomized group. A questionnaire with three measurements of the visual analogue scale of pain was given immediately after the procedure and another one thirty minutes later, as well as a satisfaction survey.RESULTS: The average age of patients in control group was 68 years (48-73 range) and 69 years (50-75 ran-ge) in treatment group. The average PSA was 7.1 ng/mL (4.8-9.8 range) in the first group and 7.3 ng/mL (4.5-9.7 range) in the second one. Average pain in the visual analogue scale in patients without intracapsular anesthesia was 8.3 (2 – 9) in the first questionnaire and 2 (0 – 4) in the second one, against 4 (0 – 8) and 1.33 (0 – 2) of the group who did receive anesthesia. If we compare both groups, we find statistically significant differences only in immediately measurements (p<0,01), not in the second questionnaire (p=0,2). We didn’t find statistically significant differences as for urethral bleeding, rectorrhagia or infection between both groups(AU)

CONCLUSION: We consider the injection of intracap-sular lidocaine a reproductible technique and effective for both improving tolerance and diminishing the pain related to transrectal ultrasound-guided prostate biopsy without increasing morbidity(AU)

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

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

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

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

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

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

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

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

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

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

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

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

Ureterohidronefrosis congénita y embarazo / Congenital ureterohydronephrosis and pregnancy

No disponible

Detección sérica de PSA mediante un test rápido (SD Bioline PSA) / Fast tenst serum PSA determination (Sd Bioline PSA)

OBJETIVO: En los últimos años han aparecido numerosos test semicuantitativos para la determinación de PSA, basados en la inmunocromatografía, realizados sobre suero o plasma. Presentamos nuestra experiencia en el uso del test SD BIOLINE PSA, que se realiza en plasma o suero para determinación cualitativa de PSA de forma rápida, y que usa como punto de corte 3 ng/mL. MÉTODO: Se analizaron un total de 54 pacientes que estuvieron ingresados en nuestra sala de hospitalización. Se extrajeron dos muestras de sangre a todos los paciente una para determinación cuantitativa de PSA en el laboratorio de nuestro hospital y otra para la determinación cualitativa con el test SD BIOLINE PSA, posteriormente comparamos ambos resultados. Dos urólogos interpretaron de forma independiente el test sin conocer los valores de PSA obtenidos en laboratorio. Para calcular el efecto del tiempo de lectura del test se leyó a los 15, 20 y 25 minutos. Los resultados fueron clasificados en una tabla de contingencia clásica, lo cual nos permitió calcular la sensibilidad y especificidad del test, así como el valor predictivo positivo y el valor predictivo negativo. RESULTADOS: La edad media fue de 71.1 años (rango de 43-96 años). De los 54 pacientes sometidos al estudio 26 (48.14%) tuvieron un PSA > 3 ng/mL (media 18,5 ng/mL, rango 3.9-66.9 ng/mL) y 28 (51.86%) presentaron un PSA < 3 ng/mL (media 0.8 ng/mL, rango 0-2.9 ng/mL), en el análisis ordinario. Los resultados en cada intervalo y por observador fueron los siguientes: 15 minutos: Observador 1: sensibilidad(S) 76.92%, especificidad (E) 100%, valor predictivo positivo (VPP) 100%, valor predictivo negativo (VPN) 82.35%; Observador 2: S 76.92%, E 100%, VPP 100%, VPN 82.35. 20 minutos: Observador 1: S 100%, E 93.33%, VPP 92.30%, VPN 100%; Observador2: S 100%, E 93.33%, VPP 92.30%, VPN 100%. 25 minutos: Observador 1: S 100%, E 85.71%, VPP 86.66%, VPN 100%; Observador 2: S 92.30%, E 92.85%, VPP 92.30%, VPN 92.85%. CONCLUSIONES: El test SDBioline cumple las características necesarias para ser utilizado como prueba de detección del PSA, es simple, rápido, barato, poco invasivo y presenta una buena efectividad (AU)

OBJECTIVES: Over the last years numerous semiquantitative PSA tests have appeared , based on serum or plasma immunochromatography. We present our experience using the SD BIOLINE PSA test, which is performed with plasma or serum for fast qualitative determination of PSA; the cut point is 3 ng/ml. METHODS: We analized 54 patients who were admitted in our hospital ward. Two blood samples were obtained from every patient, one for cuantitative PSA determination at the hospital laboratory and the other one for qualitative determination with the SD BIOLINE PSA test, and the results were compared.. Two urologists independently interpreted the test without knowing the PSA values from the lab. To calculate the effect of test reading time, readings were performed at 15, 20 and 25 minutes. Results were classified in a classic contingency table, which enabled us to calculate sensitivity and specificity of the test, as well as positive and negative predictive values. RESULTS: Mean age was 71.1 years (range 43-96 yr). From 54 patients in the study 26 (48.14%) had a PSA > 3 ng/ml (Mean 18.5 ng/ml, range 3.9-66.9 ng/ml) and 28(51.86%) PSA < 3 ng/mL (mean 0.8 ng/mL, range 0-2.9 ng/mL), in the conventional test. Results for each interval and observer were: 15 min: Observer 1: Sensitivity (S) 76,92%, specificity (E) 100%, positive predictive value (PPV) 100% , negative predictive value(NPV) 82.35%; Observer 2: S 76.92%, E 100% , PPV 100%, NPV 82.35%. 20 minutes: Observer 1: S 100%, E 93.33%, PPV 92.30%, NPV 100%; Observer 2: S 100%, E 93.33%, PPV 92.30% ,NPV 100%. 25 minutes: Observer 1: S 100% , E 85.71%, PPV 86.66%, NPV 100%; Observer 2: S 92.30%, E 92.85%, PPV 92.30%, NPV 92.85%. CONCLUSIONS: The SD Bioline PSA test complies with the characteristics required to be used as a test for prostate cancer detection, it is simple, fast, cheap, not much invasive, and has a good efficacy (AU)

[Urinary lithiasis secondary to medication in HIV+ patients receiving Indinavir]. / Litiasis medicamentosa en pacientes VIH+ en tratamiento con Indinavir.

OBJECTIVES: Therapy with protease inhibitors is commonly used in patients infected by human inmunodeficency virus (HIV). 20% of the administered dose is excreted by the kidney, and when alkaline urine is present, indinavir may crystallize forming stones and patients may experience renal colic due to this fact. METHODS: Between January 1998 and June 2005, 26 patients receiving antiretroviral treatment with protease inhibitors received care at our hospital because of renal colic or flank pain. All of them underwent physical examination, echography and urography as well as blood and urine analysis. Patients were treated ambulatory excepting those in whom oral analgesics were insufficient to control the pain. RESULTS: All patients had been treated with indinavir for longer than 12 months. They represented 4% of all patients treated with the recommended dose of Crivixan. Most of them presented flank pain, associated in most cases to microhaematuria. Five of them required hospitalization because of persistent pain in spite of endovenous analgesia. Imaging tests (echography and urography) showed functional delay of the kidney (2 cases), ureteral stasis (4 cases) and little lithiasic concretions of mild radiologic density (5 cases). Urinalysis revealed suggestive christaluria and alkaline pH. All patients required hidratation and analgesic treatment. In 3 patients indinavir dose was reduced, it was retired in another one, and 100 mg of rito-navir were added in another one. Unsuccesfuly ureteral cateterization was tried in one patient. All of them presented symptomatic improvement. CONCLUSIONS: We ought to know the capability of indinavir to form urolithiasis in HIV patients treated with protease inhibitors, although its use is decreasing along time. Prevalence of urolithiasis in these patients seems to be higher as length of treatment becomes longer. Metabolic alterations in urine have been proved in these patients, contributing to a higher incidence of lithiasis than in general population.

Litiasis medicamentosa en pacientes Vih+ eb tratamietno con Indinavir / Urinary lithiasis secondary to medication in HIV+patients receiving Indinavir

Objetivo: Los antirretrovirales inhibidores de la proteasa (IP) son fármacos utilizados en el tratamiento de pacientes afectos por el virus de la inmunodeficiencia humana (VIH). Un 20% de la dosis administrada se excreta por el riñón, que en presencia de orina alcalina puede precipitar formando cristales del propio fármaco susceptibles de provocar crisis renoureterales. Métodos: Entre enero del 1998 y junio de 2005 hemos atendido en nuestro centro a 26 pacientes con síntomas de urolitiasis y bajo el tratamiento con antirretrovirales IP. Todos ellos fueron sometidos a exploración física minuciosa, ecografía renoureteral y vesical, urografía intravenosa. Así mismo, se realizó análisis de sangre y anormales y sedimento de orina. Los pacientes fueron tratados ambulatoriamente, salvo aquellos en los que la analgesia con AINEs no fue suficiente para el control del cuadro álgico. Resultados: Todos los pacientes llevaban más de 12 meses de tratamiento con Indinavir. Los 26 pacientes con síntomas de nefrolitiasis representaban un 4% de los sujetos tratados con la dosis recomendada de Crivixan®. La mayoría presentaron dolor en fosa renal casi siempre asociado a microhematuria. De ellos, cinco pacientes requirieron ingreso en nuestra unidad por clínica no controlable de forma ambulatoria. Las pruebas diagnósticas (ecografía y/o UIV) revelaron retraso funcional del riñón (2 casos), ectasia de vía (8 casos) y pequeñas concreciones litiásicas de escasa o nula densidad cálcica (5 casos). El análisis urinario mostró cristaluria sugestiva y un pH alcalino. Todos requirieron tratamiento analgésico e hidratación. En tres casos se redujo la dosis de indinavir, en otro se retiró la medicación y en otro se añadieron 100 mgr de ritonavir. En un caso se intento cateterismo ureteral infructuosamente. La evolución fue satisfactoria en todos ellos. Conclusiones: Es preciso conocer la posibilidad de litiasis medicamentosa en pacientes HIV tratados con IP, si bien, afortunadamente, cada vez se emplean menos. La prevalencia de urolitiasis en los VIH + parece más elevada en función del tiempo de tratamiento con indinavir. Se han observado alteraciones metabólicas en la orina de estos pacientes que contribuyen a una mayor incidencia de litiasis que en la población general (AU)

Objectives: Therapy with protease inhibitors is commonly used in patients infected by human inmunodeficency virus (HIV). 20% of the administered dose is excreted by the kidney, and when alkaline urine is present , indinavir may crystallize forming stones and patients may experience renal colic due to this fact. Methods: Between January 1998 and June 2005, 26 patients receiving antiretroviral treatment with protease inhibitors received care at our hospital because of renal colic or flank pain. All of them underwent physical examination, echography and urography as well as blood and urine analysis. Patients were treated ambulatory excepting those in whom oral analgesics were insufficient to control the pain. Results: All patients had been treated with indinavir for longer than 12 months. They represented 4% of all patients treated with the recommended dose of Crivixan ®. Most of them presented flank pain, associated in most cases to microhaematuria. Five of them required hospitalization because of persistent pain in spite of endovenous analgesia. Imaging tests (echography and urography) showed functional delay of the kidney (2 cases), ureteral stasis (4 cases) and little lithiasic concretions of mild radiologic density (5 cases). Urinalysis revealed suggestive christaluria and alkaline pH. All patients required hidratation and analgesic treatment. In 3 patients indinavir dose was reduced, it was retired in another one, and 100mg of rito-navir were added in another one. Unsuccesfuly ureteral cateterization was tried in one patient. All of them presen-ted symptomatic improvement. Conclusions: We ought to know the capability of indinavir to form urolithiasis in HIV patients treated with protease inhibitors, although its use is decreasing along time. Prevalence of urolithiasis in these patients seems to be higher as length of treatment becomes longer. Metabolic alterations in urine have been proved in these patients, contributing to a higher incidence of lithiasis than in general population (AU)

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

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

Foto vaporización prostática con láser verde-KTP. Experiencia inicial en un hospital público / Greenlignt KTP-laser photovaporization. Initial experience in a public hospital

Objetivo: A pesar de que la Resección Transuretral de Próstata (RTUP) continúa siendo el patrón de referencia en el tratamiento quirúrgico de la Hiperplasia Benigna de Próstata (HBP), los buenos resultados obtenidos con el uso de nuevas fuentes de energía han asentado su uso en nuestra práctica diaria. Métodos: Entre septiembre del 2005 y enero del 2007 hemos tratado a 63 pacientes mediante fotovaporización prostática con láser KTP en nuestro servicio. En la visita preoperatoria se realizó IPSS, examen físico y tacto rectal así como ecografía renovesical y prostática con medición del residuo postmiccional, flujometría y determinación del PSA. Posteriormente los pacientes fueron revisados al mes, y a los 3, 6 y 12 meses donde se les realizó flujometría, IPSS, ecografía, PSA y se les invitó a contestar a una encuesta de satisfacción sobre el procedimiento. Resultados: La media de edad de los pacientes fue de 67 años (rango 58-85) y el volumen prostático medio preoperatorio de 48cc, (rango 34-67) presentaron niveles medio preoperatorio de IPSS de 17,7 y flujo máximo (Qmax) medio de 8,1 mL/s. 12 pacientes presentaban volúmenes residuales postmiccionales por encima de los 100 mL. La mayoría de pacientes era de medio o elevado riesgo quirúrgico anestésico. El tiempo medio quirúrgico fue de 64 minutos, (rango 45-95) usando en la mayoría de los casos una sola fibra por procedimiento, con una media de energía liberada de 175.000 Julios (rango 85.000-240.000). La estancia hospitalaria media fue de 32,2 horas (rango 19-55). En las revisiones postoperatorias se pudo constatar una disminución significativa del IPSS y una mejoría del flujo máximo medio, así como una satisfacción global con el procedimiento buena o muy buena en cerca del 80% de los pacientes. Tan solo 3 pacientes presentaron hematuria que requiera alguna medida adicional, no precisando ninguno de ellos hemotransfusión. Un paciente reingresó por infección urinaria febril y 8 pacientes refirieron disuria en grado leve o moderado en la primera visita postoperatoria. Conclusiones: La fotovaporización prostática con láser KTP es una técnica segura, reproducible y con buenos resultados a corto y medio plazo, que podría ser considerada de elección para pacientes afectos de HBP de elevado riesgo quirúrgico anestésico, añosos, con anemia crónica, o en tratamiento con antiagregantes o anticoagulantes (AU)

Objectives: Despite the fact that transurethral resection of the prostate (TURP) continues being the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH), the good results obtained with the use of new energy sources have led to their use in daily practice. Methods: Between September 2005 and January 2007, we have treated 63 patients with KTP laser photoselective vaporization of the prostate (PVP) in our service. Preoperatively we asked for IPSS, performed physical exam, digital rectal exam, abdominal , renal, bladder and prostatic ultrasound measuring postvoid residual volume, as well as flowmetry and PSA determination. Patients were revised after 1, 3, 6 and 12 months, undergoing uroflowmetry, IPSS, ultrasound and PSA; a satisfaction survey was also fulfilled at this interviews. Results: Mean age was 67 years (range 58-85) and mean preoperative prostatic volume was 48cc (range 34-67 ), mean preoperative IPSS was 17.7 and mean maximum flow 8.1 mL/s. 12 patients presented post void residual volume larger than 100mL. Most patients presented medium or high anaesthetic risk. Mean operative time was 64 minutes (range 45-95). In most cases we used just one fibre, and mean energy released was 175.000 Joules (range 85.000-24.000). Mean hospital stay was 32.2 hours (range 19-55). In postoperative revisions we could state a significant decrease of IPSS , improvement in maximum flow, and also good or very good satisfaction degree in about 80% of the patients. Only 3 of them presented hematuria that needed to be attended by the urologist, none of them needed transfusion. One patient was admitted for severe urinary infection and eight patients referred irritative low urinary tract symptoms in their first postoperative checkup. Conclusions: KTP laser PVP is a safe, reproducible technique with optimal short and middle term outcomes, which should be considered as the first choice surgical treatment in elderly patients, patients with chronic anaemic diseases or anticoagulated, and patients with high anaesthesic or surgical risk (AU(

[Inguinoscrotal bladder hernias]. / Hernias Vesicales inguinoescrotales.

OBJECTIVES: Despite the high incidence of inguinal hernias. In the general population, only a small percentage of them involve the bladder. Bladder wall weakness and bladder outlet obstruction are involved in its pathogenesis. We present our experience in the diagnosis and treatment of this rare disease. METHODS: A total of eight patients have been diagnosed of inguinoscrotal bladder hernia and treated in our center over the last 18 years. In most cases, retrograde and voiding cystourethrograms, prostatic and bladder ultrasound, and uroflowmetry have been performed. The treatment varied depending on the characteristics of the herniated bladder tissues and bladder capacity. The treatment of bladder outlet obstruction varied depending on the etiology. RESULTS: Two patients presented at the emergency room of our centre, the others were diagnosed at the outpatient clinics of our department. Resection of the herniated bladder tissue was carried out in four patients due to the quality of the tissue; bladder-pexy to the abdominis rectus muscles was performed in one patient; hernia repair with bladder reintroduction was the treatment in the other four cases. Bladder outlet obstruction was treated in six cases. Seven patients showed clinical improvement, showing normal bladder morphology on post operative cystogram. CONCLUSIONS: Bladder hernia is a rare pathology often presenting in mid age males. It should be suspected in every male with lower urinary tract obstructive symptoms and associated inguinal hernia. Retrograde and voiding cystourethrogram are the radiological diagnostic tests of choice to evaluate this disease. The treatment of choice is that of the hernia and bladder outlet obstruction.

Hernias vesicales inguinoescrotales / Inguinoscrotal bladder hernias

Objetivo: A pesar de la elevada incidencia de hernia inguinal en la población general, tan solo un pequeño porcentaje de estas incluye una porción vesical. En su patogenia están implicadas, la debilidad de la pared abdominal y la obstrucción de salida del tracto urinario inferior. En este trabajo presentamos nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente patología. Métodos: Un total de 8 pacientes han sido diagnosticados y tratados en nuestro centro, con el diagnóstico de hernia vesical inguinoescrotal en los últimos 18 años. Para alcanzar el diagnóstico se realizó uretrocistografía retrógrada y permiccional, ecografía renovesical y prostática y flujometría en la mayoría de los casos. El tratamiento realizado varió en función de las características del tejido vesical herniado y la capacidad vesical. En cuanto al tratamiento de la obstrucción infravesical, varió en función de la etiología de la misma. Resultados: Dos pacientes debutaron de forma aguda acudiendo al servicio de urgencias de nuestro centro, siendo el resto diagnósticados en las consultas externas de nuestro servicio. En 4 pacientes se realizó resección del tejido vesical herniado debido fundamentalmente a las características del mismo, realizando pexia vesical a los músculos rectos del abdomen en un caso y cura herniaria con reintroducción vesical en los cuatro restantes. En 6 pacientes se realizó tratamiento de la causa de obstrucción infravesical subyacente. Siete pacientes presentaron mejoría clínica, mostrando morfología vesical normal en la cistografía de control postoperatorio. Conclusiones: Le hernia vesical es una patología infrecuente que suele presentarse en varones de mediana edad. Ha de sospecharse en todo varón con sintomatología obstructiva del tracto urinario inferior y hernia inguinal asociada. La prueba de diagnóstico radiológico de elección para valorar esta patología es la cistografía retrógada y permiccional, y el tratamiento de elección es el propio de la hernia y el de la obstrucción infravesical (AU)

Objectives: Despite the high incidence of inguinal hernias. In the general population, only a small percentage of them involve the bladder. Bladder wall weakness and bladder outlet obstruction are involved in its pathogenesis. We present our experience in the diagnosis and treatment of this rare disease. Methods: A total of eight patients have been diagnosed of inguinoscrotal bladder hernia and treated in our center over the last 18 years. In most cases, retrograde and voiding cystourethrograms, prostatic and bladder ultrasound, and uroflowmetry have been performed. The treatment varied depending on the characteristics of the herniated bladder tissues and bladder capacity. The treatment of bladder outlet obstruction varied depending on the etiology. Results: Two patients presented at the emergency room of our centre, the others were diagnosed at the outpatient clinics of our department. Resection of the herniated bladder tissue was carried out in four patients due to the quality of the tissue; bladder-pexy to the abdominis rectus muscles was performed in one patient; hernia repair with bladder reintroduction was the treatment in the other four cases. Bladder outlet obstruction was treated in six cases. Seven patients showed clinical improvement, showing normal bladder morphology on post operative cystogram. Conclusions: Bladder hernia is a rare pathology often presenting in mid age males. It should be suspected in every male with lower urinary tract obstructive symptoms and associated inguinal hernia. Retrograde and voiding cystourethrogram are the radiological diagnostic tests of choice to evaluate this disease. The treatment of choice is that of the hernia and bladder outlet obstruction (AU)