Magnetic double-J stent: Evaluation of tolerance and impact on quality of life compared to traditional double-J stent.

INTRODUCTION: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients' quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®). MATERIAL AND METHODS: We conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal. RESULTS: There were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1.52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1.61 vs. 3, p < 0.001) associated with a shorter procedure duration (11.65 min vs. 22.17 min p < 0.001). CONCLUSIONS: The tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use.

Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access.

INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Catéter doble J magnético: evaluación de la tolerancia e impacto en la calidad de vida en comparación con el catéter doble J tradicional / Magnetic double-J stent: evaluation of tolerance and impact on quality of life compared to traditional double-J stent

Introducción: La colocación de un catéter doble J (DJ) es uno de los procedimientos más realizados en urología. Puede causar un impacto negativo en la calidad de vida, siendo necesaria una cistoscopia para su extracción. El objetivo de este estudio es evaluar la sintomatología e impacto en la calidad de vida derivados del uso del catéter DJ magnético (Black Star®) y compararla con la del DJ tradicional (OptiMed®).Material y métodosRealizamos un estudio comparativo, prospectivo y aleatorizado en 46 pacientes sometidos a ureterorrenoscopia (URS) en quienes se colocó un DJ entre agosto del 2019 y junio del 2020. De los pacientes incluidos, 23 llevaron un DJ tradicional (grupo A) y 23 un DJ magnético (grupo B). Valoramos en ambos grupos los resultados del cuestionario de síntomas de catéter ureteral (USSQ). Evaluamos el dolor de la extracción mediante la escala visual analógica (EVA) y la dificultad de la retirada. Revisamos la necesidad de atención médica por problemas relacionados con el catéter o surgidos tras la extracción.ResultadosNo observamos diferencias estadísticamente significativas en el cuestionario USSQ, ni en las complicaciones. El grupo B presentó: menor dolor de la extracción (EVA de 1,52 vs. 4, p = 0,001), menor dificultad en la retirada (1,61 vs. 3, p < 0,001) y menor tiempo de extracción (11,65 vs. 22,17 min p < 0,001).ConclusionesEl DJ magnético es un catéter ureteral que presenta una tolerancia equiparable a los tradicionales, ya que no genera un incremento de la sintomatología urinaria ni empeora la calidad de vida de los pacientes durante su uso. (AU)

Introduction: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients’ quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star ®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®).Material and methodsWe conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal.ResultsThere were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1,52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1,61 vs. 3, p < 0,001) associated with a shorter procedure duration (11,65 min vs. 22,17 min p < 0,001).ConclusionsThe tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use. (AU)

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal / Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)

[New recommendations for prostate cancer screening with PSA]. / Nuevas recomendaciones en el screening de cáncer de próstata mediante PSA.

Prostate cancer is the most frequently diagnosed cancer in men and the second cause of death in those worldwide. The fact that is a tumor with a long latency period has led to a confusion in the convenience of its diagnosis and treatment in patients at an early stage. Classically, European and American societies have not recommended prostate cancer screening with PSA, allowing physicians take this decision. In 2012, after many years full of controversy, the American organization United States Preventive Task Force recommended to abandon its use. The results of these statements carried an increase in the incidence of the metastatic prostate cancer and, therefore, a rise in its mortality. In 2018, after these consequences, the European Association of Urology released new recommendations in favor of screening based on PSA for the first time. In 2019, guidelines were updated with no changes in its recommendations.

Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift(R) bajo anestesia local y sedación / Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift(R) under local anaesthesia and sedation

Introducción: El tratamiento de los síntomas del tracto urinario inferior secundarios a hiperplasia benigna de próstata con la utilización del sistema Urolift(R) se lleva realizando desde 2005 con buenos resultados a medio plazo. En este trabajo presentamos nuestra experiencia realizando esta técnica bajo anestesia local y sedación en 2 centros españoles. Material y métodos: Se llevó a cabo un estudio prospectivo con 20 pacientes tratados con Urolift(R) bajo anestesia local y sedación entre abril de 2017 y abril de 2018. El protocolo anestésico consistía en la colocación de 2 lubricantes con lidocaína fríos (el primero 10 min antes de la intervención y el segundo momentos antes de iniciar la endoscopia). A un tercio de los pacientes se les añadió un bloqueo prostático similar al que se realiza en las biopsias de próstata y, según la tolerancia, durante el procedimiento, se les añadió 1 mg de midazolam intravenoso. El objetivo primario es evaluar la tolerabilidad de este procedimiento bajo anestesia local usando la escala visual analógica. Resultados: El procedimiento ha sido realizado en 20 pacientes en 2 centros diferentes usando el mismo protocolo anestésico. La puntuación media en la escala escala visual analógica de dolor fue de 1,37 para la introducción del cistoscopio y de 1,19 para la colocación de los implantes. A la pregunta de si el dolor había sido mayor, menor o igual al de la cistoscopia diagnóstica, solo el 20% de los pacientes respondieron que había sido mayor. En todos los casos hubo una buena tolerancia al procedimiento, no precisándose en ninguno de ellos el cambio del tipo de anestesia. Conclusiones: Consideramos que la utilización del Urolift(R) bajo anestesia local y sedación es un método bien tolerado, seguro y eficaz para el tratamiento de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata

Introduction: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift(R) system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. Material and methods: A prospective study was conducted with 20 patients treated with Urolift(R) under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10 min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. Results: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. Conclusions: We consider that the Urolift(R) system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift® under local anaesthesia and sedation. / Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift® bajo anestesia local y sedación.

INTRODUCTION: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift® system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. MATERIAL AND METHODS: A prospective study was conducted with 20 patients treated with Urolift® under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. RESULTS: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. CONCLUSIONS: We consider that the Urolift® system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo / High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience

Introducción: Hoy en día, el tratamiento del cáncer de próstata localizado busca minimizar el impacto en la función sexual y la continencia urinaria. En este sentido, la terapia con ultrasonido de alta intensidad ofrece resultados interesantes. Presentamos nuestra experiencia con esta técnica en 2 centros españoles. Material y métodos: Revisión retrospectiva de 75 pacientes con cáncer de próstata localizado tratados con terapia con ultrasonido de alta intensidad entre marzo de 2007 y julio de 2016. Se evaluaron los resultados oncológicos y las complicaciones perioperatorias, así como el impacto en la función sexual y la continencia. Resultados: Sesenta y siete pacientes fueron analizados. El seguimiento medio fue de 7,2 años. El PSA nadir fue de 0,2 ng/ml (0-3); 24 pacientes (35,5%) presentaron recidiva bioquímica y en 18 se realizó una nueva biopsia, evidenciando 10 casos (55,5%) con recidiva anatomopatológica. La supervivencia libre de recidiva bioquímica global a 5 y 8 años fue de 93,2 y 80,5%, respectivamente. La supervivencia específica para cáncer a 5 y 8 años fue en ambos casos de un 96%. En el postoperatorio, 50 pacientes (74,6%) eran continentes, 16 (23,9%) reportaban incontinencia leve y uno (1,5%), moderada. La mediana del International Index of Erectile Function-5 previa y postratamiento fue de 17 (5-25) y 16 (2-23) puntos, respectivamente. Reportaron disfunción eréctil de novo 9 pacientes (13,5%). Conclusión: La terapia con ultrasonido de alta intensidad parece ser una alternativa segura para el tratamiento del cáncer de próstata localizado, especialmente de bajo riesgo. En nuestra experiencia, esta técnica ofrece ventajas en la conservación de la continencia urinaria, y los resultados oncológicos parecen ser alentadores a medio plazo. Dada la evolución natural del cáncer de próstata, se requieren estudios a largo plazo y con mayor casuística que corroboren estos resultados

Introduction: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. Material and methods: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. Results: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2 ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). Conclusion: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results

High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience. / Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo.

INTRODUCTION: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. MATERIAL AND METHODS: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. RESULTS: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). CONCLUSION: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.

Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex / Long-term follow-up for the treatment of male urinary incontinence with the Remeex system

Objetivos: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo (IUE) posprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, técnica de implantación y su adecuado ajuste. Igualmente, pretendemos comprobar si las últimas modificaciones realizadas en dicho dispositivo, que constituye el SRM-II, han supuesto un menor número de reajustes de la malla. Material y método: Desde marzo de 2007 hasta marzo de 2014 hemos intervenido a 24 varones afectos de IUE posprostatectomía con edades comprendidas entre 55 y 78 años (media 67 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida. Resultados: Todos los pacientes, excepto en 2 casos que precisaron retirada del sistema, se mantienen secos, necesitando ocasionalmente 9 de ellos (39%) compresa de seguridad si realizan ejercicio físico intenso. El número medio de reajustes fue de 2,4 (rango 0-6). La puntuación del Incontinence Impact Questionnaire realizado antes de la intervención y 6 meses después pasa de 79±7 puntos a 11±3, siendo el grado de satisfacción muy elevado. Conclusiones: El SRM constituye una opción terapéutica válida para la incontinencia posprostatectomía, siendo una técnica reproducible, de fácil ejecución, con una baja tasa de complicaciones, proporcionando unos resultados excelentes y duraderos. Asimismo, parece existir una clara tendencia a la disminución del número de reajustes con el nuevo SRM-II

Objectives: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. Material and method: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. Results: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. Conclusions: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II

Long-term follow-up for the treatment of male urinary incontinence with the Remeex system. / Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex.

OBJECTIVES: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. MATERIAL AND METHOD: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. RESULTS: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. CONCLUSIONS: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II.

[Rhabdomyolysis after laparoscopic nephrectomy: case report]. / Rabdomiolisis tras nefrectomía laparoscópica; a propósito de un caso.

OBJECTIVE: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. METHODS: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. RESULTS: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60 degrees flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. CONCLUSIONS: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery.

[Greenlight Laser Photoselective vaporization of the prostate (PVP). Surgical advantages in risk patients]. / Fotovaporización prostática (FVP) mediante láser verde. Ventajas quirúrgicas en pacientes de riesgo.

It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.

[Use of urography by magnetic resonance for the study of the urinary apparatus versus conventional urography]. / Uso de la urografia por resonancia magnética en el estudio del aparato urinario frente a la urografía convencional.

UNLABELLED: Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. OBJECTIVE: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU. MATERIALS AND METHODS: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. RESULTS: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%. CONCLUSION: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.

Complicaciones de la prostatectomía radical: evolución y manejo conservador de la incontinencia urinaria / Radical prostatectomy complications: evolution and conservative management of urinary incontinence

Objetivos: La prostatectomía radical retropúbica continúa siendo el tratamiento de elección para el cáncer de próstata órganoconfinado. Realizamos un estudio retrospectivo en el que valoramos las complicaciones de esta cirugía y su evolución en el tiempo así como la cantidad del tratamiento conservador, especialmente la rehabilitación perineal precoz, en la recuperación de la continencia tras esta intervención. Material y métodos: Durante el período comprendido entre diciembre de 1998 a enero del 2005 hemos intervenido en nuestro servicio a 168 pacientes afectos de adenocarcinoma prostático confinado clínicamente a la glándula mediante prostatectomía radical retropúbica. Retiramos la sonda vesical el decimocuarto día del postoperatorio. A los pacientes que presentarion incontinencia urinaria (IU) de esfuerzo se les instruyó para la realización de ejercicios para fortalicer el suelo pélvico. Realizamos un seguimiento clínico el primer, tercer y sexto mes tras la cirugía, y posteriormente de forma semestral. Resultados: De los 168 pacientes intervenidos, el 15% requirió hemotransfusión en el postoperatorio inmediato. Otras complicaciones precoces, de mucha menos incidencia, fueron la perforación intestinal, la infección de la herida quirurgica y la foramción de hematoma en el lecho quirúrgico. Entre las complicaciones tardías más frecuentes registramos la disfunción eréctil, que se presentó en 164 pacientes (98%), alteraciones miccionales en 32 pacientes (19%) y alteraciones intestinales en aproximadamente el 11%. Entre las alteraciones miccionales encontradas, la más frecuente fue la IU (64%) si bien la mayoría de ellas eran de carácter leve (34%) y todas mejoraron durante los primeros seis meses posteriores a la cirugía. Conclusiones: La IU es el principal condicionante de la calidad de vida de los pacientes que son sometidos a prostatectomía radical. Si bien el porcentaje de pacientes que la presenta es alto, la mayoría son de grado leve o moderado y pueden mejorar ostensiblemente con los ejercicios de fortalecimiento del suelo pélvico, constituyéndose así como un arma fundamental en el menejo de estos pacientes, acompañada o no del uso de absorbentes, de la terapia farmacológica o del empleo de colectores peneanos

Objectives: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complication of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary incontinence. Materials and methods: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and there after every six monoths. Results. Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion inthe immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. Conclusions. Radical prostatectomy continues to the most effective treatment for the non spared prostate cancer, in spite, of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors

[Endoscopic treatment of the benign prostatic hyperplasia with local anesthesia and sedation in patients with high surgical or anaesthesical risk]. / Tratamiento endoscópico de la hiperplasia benigna de próstata bajo anestesia local-sedación en pacientes de alto riesgo.

INTRODUCTION AND OBJECTIVE: [corrected] The aging of the population causes an increase of the number of men affected by benign prostatic hyperplasia (BPH) with a large number of pathology associated that may limit its surgical treatment. In this study we try to show the effectiveness and security of local anaesthesia and sedation in the endoscopic treatment of the BPH in patients with high surgical-anaesthetic risk. METHODS: During the last 4 years, 38 patients underwent surgical treatment of BPH with ages between 78 and 86 years (average 81,4 +/- 3,2) with severe obstructive prostatic syndrome and high surgical-anaesthetic risk. 15 patients underwent, transurethral incision of prostate (TUIP) and in 23 patients, transurethral resection (TURP) was performed. The blockade anesthetic was made by transrectal periprostatic infiltration finger-guided with 10-15 millilitres of lidocaine 2%. During the procedure an intravenous perfusion of propofol and remifentanil was administered. The obtained results as well as the patient's satisfaction degree was evaluated by means of the elaboration of a questionnaire. RESULTS: The average length of the surgical treatment was of 12 +/- 5 minutes (rank 8 - 25), having itself not stated complications derived from the anesthetic technique. They referred a slight annoyance 4 patients (11%) that was treated increasing the rate of the sedative perfusión. The satisfaction's degree with the received treatment has been good in the 95% of patients. CONCLUSIONS: We considered that the TUIP as much as TURP made under local anesthesia with sedation are safe, effective methods and well tolerated, that fundamentally are indicated in aged patients and when the surgical-anesthetic risk is elevated.

Tratamiento endoscópico de la hiperplasia benigna de próstata bajo anestesia local-sedación en pacientes de alto riesgo / Endoscopic treatment of the benign prostatic hyperplasia with local anesthesia and sedation in patients with high surgical or anaesthesical risk

Introducción y objetivo: El envejecimiento de la población comporta un incremento del número de varones afectos de hiperplasia benigna de próstata (HBP) con múltiple patología asociada que limita su tratamiento quirúrgico. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local-sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico. Método: Durante los últimos 4 años hemos intervenido a 38 pacientes con edades comprendidas entre 78 y 86 años (media 81,4 ± 3,2) con síndrome de prostatismo obstructivo severo y riesgo quirúrgico-anestésico elevado. En 15 pacientes se practicó incisión transuretral de próstata (ITUP) y en los 23 restantes resección transuretral (RTUP). El bloqueo anestésico se realizó mediante infiltración periprostática transrectal digito-dirigida con 10-15 ml de lidocaína al 2%. Durante el procedimiento se administró una perfusión intravenosa de propofol y remifentanilo. Se evalúan los resultados obtenidos así como el grado de satisfacción de los pacientes mediante la elaboración de un cuestionario. Resultados: La duración media de la intervención fue de 12 ± 5 minutos (rango 8 - 25), no habiéndose constatado complicaciones derivadas de la técnica anestésica. Refirieron una molestia leve 4 pacientes (11%) que se resolvió aumentando la velocidad de la perfusión sedante. El grado de satisfacción con el tratamiento recibido ha sido del 95%. Conclusiones: Consideramos que tanto la ITUP como RTUP realizadas bajo anestesia local-sedación son métodos seguros, eficaces y bien tolerados, que están fundamentalmente indicados en pacientes añosos y cuando el riesgo quirúrgico-anestésico es elevado

Introduction and objetive: The aging of the population causes an increase of the number of men affected by benign prostatic hyperplasia (BPH) with a large number of pathology associated that may limit its surgical treatment. In this study we try to show the effectiveness and security of local anaesthesia and sedation in the endoscopic treatment of the BPH in patients with high surgical- anaesthetic risk. Methods: During the last 4 years, 38 patients underwent surgical treatment of BPH with ages between 78 and 86 years (average 81,4± 3,2) with severe obstructive prostatic syndrome and high surgical-anaesthetic risk. 15 patients underwent, transurethral incision of prostate (TUIP) and in 23 patients, transurethral resection (TURP) was performed. The blockade anesthetic was made by transrectal periprostatic infiltration finger-guided with 10-15 millilitres of lidocaine 2%. During the procedure an intravenous perfusion of propofol and remifentanil was administered. The obtained results as well as the patient’s satisfaction degree was evaluated by means of the elaboration of a questionnaire . Results: The average length of the surgical treatment was of 12 ± 5 minutes (rank 8 - 25), having itself not stated complications derived from the anesthetic technique. They referred a slight annoyance 4 patients (11%) that was treated increasing the rate of the sedative perfusión. The satisfaction’s degree with the received treatment has been good in the 95% of patients. Conclusions: We considered that the TUIP as much as TURP made under local anesthesia with sedation are safe, effective methods and well tolerated, that fundamentally are indicated in aged patients and when the surgical-anesthetic risk is elevate

[Radical prostatectomy complications: evolution and conservative management of urinary incontinence]. / Complicaciones de la prostatectomia radical: evolución y manejo conservador de la incontinencia urinaria.

OBJECTIVES: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence. MATERIALS AND METHODS: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months. RESULTS: Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. CONCLUSIONS: Radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors.