RESUMO
Objetivo: Comparar los resultados de eficacia y seguridad del láser tulio 150W frente a láser verde 120W en el tratamiento de la hiperplasia benigna de próstata a corto plazo (12 meses de la cirugía). Material y métodos: Estudio retrospectivo observacional, donde se incluyen varones intervenidos con la técnica de fotovaporización prostática durante un periodo de 4 años en nuestro centro. Se comprobó la homogeneidad de la muestra, y se compararon las complicaciones postoperatorias (retención aguda de orina, reingreso, necesidad de transfusión), los fracasos al año de la cirugía (reintervenciones, flujo máximo < 15ml/seg, ausencia de mejoría en el I-PSS) y disminución de PSA al año de la cirugía. Análisis bivariante mediante Chi-cuadrado y «t» de Student. Resultados: Ciento dieciséis pacientes tratados con tulio y 118 con láser verde. Muestra homogénea para variables preoperatorias (p>0,05). No se objetivaron diferencias en las complicaciones: en retenciones agudas de orina, 4,3% con tulio y 6,8% con láser verde (p = 0,41); en reingresos 2,6% con tulio y 1,7% con láser verde (p = 0,68); en necesidad de transfusión 2,6% con tulio y 0% con láser verde (p = 0,12). Tampoco se observaron diferencias en el porcentaje de pacientes reintervenidos (1,7% en el grupo de tulio, 5,1% en el de láser verde, p = 0,28), ni en el de individuos con Qmáx menor de 15 ml/seg (6,9% con tulio, 6,77% con láser verde, p = 0,75), ni en el de ausencia de mejoría del I-PSS (5,2% con tulio, 3,4% con láser verde, p = 0,65). Tampoco hubo diferencia en los niveles de PSA en ng/ml al año de la cirugía: con tulio 2,78 ± 2,09 y con láser verde 1,83±1,48 (p = 0,75). Conclusiones: La fotovaporización prostática con láser tulio 150W es comparable a la realizada con láser verde de 120 W para el tratamiento de los síntomas obstructivos del tracto urinario inferior por HBP, siendo ambas técnicas eficaces y seguras a los 12 meses de la intervención. Futuros estudios prospectivos aleatorizados son necesarios para confirmar esta conclusión sobre ambas técnicas
Objective: To compare the results of efficacy and safety of Thulium laser 150 W against Greenlight laser 120 W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow < 15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. Results: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P > .05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P = .41); in readmissions, 2.6% with thulium and 1.7% with green laser (P = .68); in need for transfusion, 2.6% with thulium and 0% with green laser (P = .12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P = .28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P = .75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P = .65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78 ± 2.09 and with green laser 1.83 ± 1.48 (P = .75). Conclusions: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques
Assuntos
Humanos , Masculino , Hiperplasia Prostática/terapia , Reoperação/métodos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Terapia a Laser , Resultado do Tratamento , Estudos Retrospectivos , Complicações Pós-Operatórias , Lasers/classificação , LasersRESUMO
OBJECTIVE: To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). MATERIAL AND METHODS: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. RESULTS: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75). CONCLUSIONS: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.
Assuntos
Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Túlio/uso terapêutico , Idoso , Seguimentos , Humanos , Lasers de Estado Sólido/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Túlio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Retenção UrináriaRESUMO
OBJETIVO: Presentar dos casos de hemorragia renal tras litotricia extracorpórea con ondas de choque (LEOC) y su manejo terapéutico. MÉTODO: Descripción de los casos clínicos, además del diagnóstico y el manejo terapéutico de este tipo de complicaciones. RESULTADOS: Presentamos dos casos de pacientes con hemorragia renal tras LEOC, las cuales fueron realizadas sin incidencias inmediatas. Uno de los casos, tras objetivar laceración importante del parénquima renal, precisó dos embolizaciones para su resolución a corto plazo, aunque la paciente finalmente falleció por las complicaciones derivadas de la hemorragia. El otro se resolvió con manejo conservador. CONCLUSIONES: Aunque la hemorragia renal es una complicación infrecuente tras LEOC, debe sospecharse cuando el paciente presente clínica compatible, pues aunque la mayoría de los casos se resuelven de forma conservadora, en ocasiones son necesarios tratamientos específicos de la hemorragia. La edad avanzada y la presencia de comorbilidades vasculares parecen relacionarse con un mayor riesgo de hemorragia tras LEOC
OBJECTIVE: To report two cases of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL) and their therapeutic management. METHODS: Description of the clinical cases, together with the diagnosis and therapeutic management of these complications. RESULTS: We present two cases of patients with renal hemorrhage after ESWL, which were performed without immediate complications. One of the cases, after detecting an important laceration of the renal parenchyma, needed two embolization sessions for its short-term resolution; however, the patient finally passed away due to the complications derived from hemorrhage. The other case was solved through conservative management. CONCLUSIONS: Even though hemorrhage is an infrequent complication after ESWL, it should be suspected when the patient presents compatible clinical symptoms, since even though most cases are resolved in a conservative manner, on some occasions specific treatments for the hemorrhage are necessary. Old age and the presence of vascular comorbidities seem to be related to a higher risk of hemorrhage after ESWL
