Generación in vitro de un sustituto de pared vesical humana obtenido mediante ingeniería tisular / In vitro generation of a human bladder wall substitute by tissue engineering

Objetivos. Numerosas patologías que afectan a la vejiga, de origen congénito (extrofia) o adquirido (traumatismos, tumores), requieren la reconstrucción de la pared vesical utilizando intestino delgado, sigma o estómago, los cuales no están exentos de complicaciones. Por ese motivo, en el presente trabajo pretendemos desarrollar un nuevo modelo de pared vesical humana mediante ingeniería tisular que pudiese tener una utilidad clínica. Material y métodos. En primer lugar, se procedió a generar cultivos primarios de células epiteliales y estromales de la mucosa vesical a partir de pequeñas biopsias de la pared vesical humana, utilizando para ello técnicas de digestión enzimática mediante tripsina-EDTA y colagenasa. Posteriormente, se generó un sustituto tridimensional de la mucosa vesical utilizando como soporte biomateriales de fibrina-agarosa. El análisis de las muestras se realizó a los 14 días mediante examen histológico de muestras teñidas con hematoxilina-eosina. Resultados. La aplicación de los métodos de digestión enzimática permitió generar eficientemente cultivos primarios de células epiteliales y estromales de la mucosa vesical humana, comprobándose que la tasa de proliferación de las células estromales era superior a la de las células epiteliales. Una vez generados los sustitutos de la pared vesical, se comprobó el adecuado nivel de biocompatibilidad del biomaterial y las células estromales y epiteliales. La estructura histológica de los sustitutos de pared vesical presentaba una gran analogía con la mucosa vesical humana nativa. Conclusiones. El tejido vesical generado por ingeniería tisular muestra importantes similitudes estructurales e histológicas con el tejido vesical nativo. Estos resultados sugieren que los tejidos generados mediante ingeniería tisular podrían tener utilidad terapéutica en el futuro (AU)

Introduction. Certain urological congenital conditions, such as bladder exstrophy and acquired conditions such as trauma and tumors may require the use of different tissues like small bowel, sigmoid colon or stomach for bladder reconstruction. However, these tissues are often associated to important complications. The aim of this study is to develop a novel substitute of the human bladder wall by tissue engineering. Material and methods. We first generated primary cell cultures of epithelial and stromal bladder mucosa cells from small tissue biopsies of human bladder by using enzymatic methods based on trypsin-EDTA and collagenase I. Then, a three-dimensional substitute of the bladder mucosa was generated using fibrin-agarose biomaterials. The analysis of the tissue substitutes was carried out at day 14th of development by histological examination of samples stained with hematoxylin-eosin. Results. The use of enzymatic digestion methods allowed us to efficiently generate primary cell cultures of the human bladder epithelial and stromal cells. The proliferation rate was higher in stromal cells as compared to epithelial cells. Once the bladder mucosa substitutes were generated, a good biocompatibility of the stromal and epithelial cells into the biomaterial was found. The histological structure of the bladder wall substitutes was analogue to that of the native human bladder mucosa. Conclusions. The bladder mucosa substitute generated by tissue engineering showed structural and histological similarities with the native human bladder tissues and open the door to the future therapeutic use of these bioengineered tissues (AU)

[In vitro generation of a human bladder wall substitute by tissue engineering]. / Generación in vitro de un sustituto de pared vesical humana obtenido mediante ingeniería tisular.

INTRODUCTION: Certain urological congenital conditions, such as bladder exstrophy and acquired conditions such as trauma and tumors may require the use of different tissues like small bowel, sigmoid colon or stomach for bladder reconstruction. However, these tissues are often associated to important complications. The aim of this study is to develop a novel substitute of the human bladder wall by tissue engineering. MATERIAL AND METHODS: We first generated primary cell cultures of epithelial and stromal bladder mucosa cells from small tissue biopsies of human bladder by using enzymatic methods based on trypsin-EDTA and collagenase I. Then, a three-dimensional substitute of the bladder mucosa was generated using fibrin-agarose biomaterials. The analysis of the tissue substitutes was carried out at day 14th of development by histological examination of samples stained with hematoxylin-eosin. RESULTS: The use of enzymatic digestion methods allowed us to efficiently generate primary cell cultures of the human bladder epithelial and stromal cells. The proliferation rate was higher in stromal cells as compared to epithelial cells. Once the bladder mucosa substitutes were generated, a good biocompatibility of the stromal and epithelial cells into the biomaterial was found. The histological structure of the bladder wall substitutes was analogue to that of the native human bladder mucosa. CONCLUSIONS: The bladder mucosa substitute generated by tissue engineering showed structural and histological similarities with the native human bladder tissues and open the door to the future therapeutic use of these bioengineered tissues.

[Statistical analysis of the influence of the virus of papilloma human in the development of the vesical carcinoma]. / Análisis estadístico de la influencia del virus del papiloma humano en el desarrollo del carcinoma vesical.

INTRODUCTION: The bladder cancer is an important disease by its morbi-mortality and its multifactorialidad. At the moment, between the possible aetiology agents that they have been indicated is the infection by the virus of papilloma human (VPH). The objective study is to analyse, by meta-analysis, the relationship between bladder cancer and infection by human papillomavirus. MATERIAL AND METHODS: We made a search in the electronic data base MEDLINE of the articles published until September of the 2004 that relate the infection of the VPH to the bladder tumors. Of 414 listed articles, we selected 38 articles. RESULTS: The articles were classified in two groups, according to they use or non methods based on the detection of the DNA. In articles based on the detection of the DNA, it was that the global proportion from the cases that had contact with the virus, through the detection of the genome was of the 19.4% (95% CI 0.160 to 0.228). Of the total of studies based on the detection of the DNA 8 were selected, to show to a group defined control, in which, the OR was investigated. If we combined the ORs, we obtain an OR estimation of 3.2 (95% CI 1.19 to 8.60) and p = 0.02. CONCLUSIONS: Most of these studies showed the relation rose at the beginning of the study. Although the majority lacked a group defined control, is possible to analyze the value of the Odds global ratio due to the homogenous behaviour of the studies with defined cases and controls affluent. This demonstrated to association between VPH and the bladder cancer.

Análisis estadístico de la influencia del virus del papiloma humano en el desarrollo del carcinoma vesical / Statistical analysis of the influence of the virus of pailoma human in the development of the vesical carcinoma

Introducción: El carcinoma de vejiga es una enfermedad importante por su morbi-mortalidad y su multifactorialidad. Actualmente, entre los posibles agentes etiológicos que se han señalado, se encuentra la infección por el virus del papiloma humano (VPH). El objetivo del estudio es analizar, mediante la realización de un meta-análisis, la relación existente entre el cáncer vesical y la infección por el virus del papiloma humano. Material y métodos: Realizamos una búsqueda en la base de datos electrónica MEDLINE de los artículos publicados hasta septiembre del 2004 que relacionan la infección del VPH con los tumores vesicales. De los 414 artículos listados, seleccionamos 38 artículos. Resultados: Los artículos se clasificaron en dos grupos, según empleen o no métodos basados en la detección del ADN. En los artículos basados en la detección del ADN, resultó que la proporción global de los casos que tuvieron contacto con el virus, a través de la detección del genoma fue del 19,4% (IC 95%: 0,160-0,228). Del total de estudios basados en la detección del ADN se seleccionaron 8, por mostrar un grupo control definido, en los cuales, se investigó la OR. Si combinamos las ORs, obtenemos una OR estimada de 3,2 (IC al 95% de 1,19 a 8,60) y una p=0,02. Conclusiones: La mayor parte de estos estudios pusieron de manifiesto la relación planteada al inicio del estudio. Aunque la mayoría carecían de un grupo control definido, es posible analizar el valor de la Odds ratio global debido al comportamiento homogéneo de los estudios con casos y controles bien definidos. Esto demostró una asociación entre VPH y el cáncer de la vejiga

Introduction: The bladder cancer is an important disease by its morbi-mortality and its multifactorialidad. At the moment, between the possible aetiology agents that they have been indicated is the infection by the virus of papilloma human (VPH). The objective study is to analyse, by meta-analysis, the relationship between bladder cancer and infection by human papillomavirus Material and methods: We made a search in the electronic data base MEDLINE of the articles published until September of the 2004 that relate the infection of the VPH to the bladder tumors. Of 414 listed articles, we selected 38 articles. Results: The articles were classified in two groups, according to they use or non methods based on the detection of the DNA. In articles based on the detection of the DNA, it was that the global proportion from the cases that had contact with the virus, through the detection of the genome was of the 19.4% (95% CI 0.160 to 0.228). Of the total of studies based on the detection of the DNA 8 were selected, to show to a group defined control, in which, the OR was investigated. If we combined the ORs, we obtain an OR estimation of 3.2 (95% CI 1.19 to 8.60) and p=0.02. Conclusions: Most of these studies showed the relation rose at the beginning of the study. Although the majority lacked a group defined control, is possible to analyze the value of the Odds global ratio due to the homogenous behaviour of the studies with defined cases and controls affluent. This demonstrated to association between VPH and the bladder cancer

[Ureteral iatrogenic ligature. Endoscopic resolution]. / Ligadura yatrógena ureteral resuelta via endoscópica.

The iatrogenic trauma of ureter is a complication that appears according to the different series between the 0.05-30% from the abdominal or pelvic surgeries. It the same affects to both ureters, being the rare bilateral ureteral trauma. The most frequent location is in the lower ureter. Maybe this fact must to that that is the patron of ureter more related by viacinity to the structures or organs in wich surgery is made. The most frequent causes are the gynecological ones, followed of the surgery of colon and vascular surgery. The reconstruction techniques depend on the level of the injury. The maneuvers of support and the endourology treatment can be useful for the resolution of these injuries.

Ligadura yatrógena ureteral resuelta vía endoscópica / Ureteral iatrogenic ligature. Endoscopic resolution

Introducción: La medida de las tasas de infección nosocomial constituye un indicador de calidad asistencial, permitiendo adoptar medidas de prevención y control. Se ha desarrollado un plan de vigilancia de infección nosocomial en los hospitales, demostrando ser un método eficaz para disminuir su incidencia. Objetivo: Conocer los indicadores y características de la infección nosocomial en general y de la infección del sitio quirúrgico en particular en un servicio de Urología de forma global y por procedimientos. Material y métodos: Estudio prospectivo mediante el sistema de vigilancia epidemiológica entre 2002-2005 en 4.618 pacientes ingresados al menos 24 horas, practicándose un total de 3.096 intervenciones. Resultados: Se observó una tasa global de infección nosocomial del 6,10%, de infección urinaria del 3,42% y de infección del sitio quirúrgico del 2,81%. De esta última por procedimientos, la cistectomía se sitúa en el 22,8%, seguido de la cirugía del riñón y uréter (6,6%) y de la cirugía abierta de próstata (4,36%). Los gérmenes más frecuentemente aislados en la infección del sitio quirúrgico son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%). En la infección urinaria los gérmenes más frecuentes son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%) Conclusión: Las tasas de infección nosocomial son inferiores a los valores estandares publicados. La mayor tasa de infección del sitio quirúrgico se presenta en las cirugías más complejas técnicamente, siendo Escherichia Coli, el agente etiológico más frecuente. La vigilancia de la infección del sitio quirúrgico y factores relacionados permiten incorporar elementos de mejora en la práctica clínico-quirúrgica, aportando un indicador de referencia en análisis posteriores

Introduction: Nosocomial infection rates constitute an indicator of welfare quality, permitting to adopt measures of prevention and control. It has been developed a surveillance plan of the nosocomial infection in hospitals, showing to be an efficient method to diminish its incident. Objective: To know the indicators and characteristics of the nosocomial infection and of the infection of the site surgical particularly, in a urology service in a global form and by procedures. Matherial and methods: Prospective study by means of the epidemiological surveillance system from 2002 to 2005 in 4.618 patients hospitalised at least 24 hours, with a total of 3.096 surgical. Results: The overall incidence of nosocomial infection was 6,10%, 3.42% for urinary infection and 2,81% for the infection of the chirurgical site. For procedures, the incidence of the infection of the surgical site for cistectomy was 22,8%, 6,6% for surgery of kidney and ureter and 4,36% for open surgery of prostate. Eschericia Coli (43,6%) was the most frequently isolated organism, accounting for 43,6% of the causative organisms in the infection of the surgical site and 43,6% in the urinary infection. Pseudomonas aeruginosa is the next organism in frecuency with a 15% in both infections. Conclusion: Our nosocomial infection rates are lower than the published standard values. The main infection rate of the surgical sites present in the most complex surgical techniques, whereas Escherichia Coli is the most frecuently isolated ethiological agent. The surveillance of the infection of the surgical site and related factors permit to incorporate improvements in the clinical-surgical practice which will be an indicator of reference in subsequent analysis