Hematocele secondary to rupture of an abdominoscrotal hydrocele.

OBJECTIVE: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient. METHODS AND RESULTS: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space. CONCLUSIONS: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment.

The use of botulinum toxin in benign prostatic hyperplasia.

The injection of Botulinum toxin type A (BoNT/A) into the prostate is a minimally invasive alternative treatment for lower urinary tract symptoms. To summarize the action mechanisms of BoNT/A on experimental animals and to analyze its effectiveness according to published clinical studies, we located 24 papers on the treatment of HBP with BoNT/A. The doses applied ranged from 100 (OnabotA) to 600 U (OnabotA and AbobotA). The IPSS score presented a mean post-treatment reduction, for all series, of 10.8 + 2.66 points. Other significant results included the overall mean reduction in QoL score of 2.1 ± 0.62 points, and the pre and post-treatment differences in prostate volume (22.43 ± 20.2 cm(3)), post-voiding residue (76.77 + 51.72 cm(3)) and PSA (1.15 + 0.93 ng/ml). However, only two clinical trials were on sufficient quality to be selected for meta-analysis, and it was observed that the difference of the means, pre- and post-treatment of maximum flow, prostate volume, IPSS and PSA were not statistically significant (P = 0.18). Neither was there any statistically significant difference between pre- and post-treatment post-voiding residue (P = 0.65). In conclusion, BoNT/A alleviates lower urinary tract symptoms due to HBP, but different studies present considerable variations regarding the dose administered, inclusion criteria and follow-up time, as well as poorly defined retreatment, losses to follow up and, above all, a high degree of variability in the communication of results (with large standard deviations). In consequence, further clinical trials are needed.

Barbagli's dorsal urethroplasty. Analysis of results and factors for success.

OBJECTIVES: Dorsal urethroplasty as described by Barbagli has gained wide acceptance in the treatment of urethral stricture, given the simplification afforded by obtaining a free graft versus a flap. We present a series of 50 patients treated in our department of urethral stricture by dorsal onlay free graft urethroplasty (Barbagli's technique), in combination or not to other techniques in more complex strictures. METHODS: The average age of patients was 48.8 years (23-77), the mean follow up 42.9 months (12-96) and the most frequently observed etiology has been the inflammatory urethral stricture (50%). RESULTS: Overall success rate was 82% (41 cases) and failure 18% (9 cases). In the longer follow-up group, there was a slight drop in success rate of 80% (24 cases) without any significant differences between groups (p= 0.9). Analyzing the variables length of free graft (p= 0.50, p> 36= 0.53), age (p= 0.12, p>36= 0.59), etiology of stricture (p= 0.77, p>36 = 0.77) and type of graft used (p=0.24, p>36= 0.38) did not show any influence on the final outcome of surgery, both in the total sample and the subgroup with follow-up > 36 months. The location of the stricture in bulbar urethra has shown better functional outcome than those operated on for strictures affecting also other urethral locations (p= 0.001) maintaining that result in the group of longer follow up (p>36= 0,001). The lack of treatment prior to urethral surgery has influenced the success of it, since 90.6% of patients without prior treatment before urethroplasty have seen a good functional outcome, compared to treatment prior to surgery that obtained a 66.7% (p= 0.03). This significance is also demonstrated in the group of follow-up > 36 months (p>36= 0.01). CONCLUSION: The dorsal onlay free graft urethroplasty is a versatile and reproducible technique with acceptable results which allows combination with other techniques when the stenosis extends to the penile urethra. In exceptional cases of panurethral strictures secondary to lichen sclerosus when there is no significant spongiofibrosis and an acceptable urethral plate, can be applied to the whole urethra.

Percutaneous tibial nerve stimulation in treatment of overactive bladder: when should retreatment be started?

OBJECTIVE: To study the response to posterior tibial nerve stimulation in patients with overactive bladder refractory to medical treatment. METHODS: A cohort of 53 patients were treated by posterior tibial nerve stimulation and followed up for a maximum of 24 months. All patients completed the International Consultation on Incontinence Modular Questionnaire-Short Form quality of life questionnaire and kept a urination diary to record the daytime urination frequency and night-time urination frequency. Urodynamic studies were also conducted. RESULTS: At 6 months of follow-up, a cure/improvement rate of 92.4% (49 of 53 cases) had been achieved. Ten patients were given additional treatment and were excluded from subsequent follow-up analysis. At 12 months of follow-up, a cure/improvement rate of 91.69% had been achieved (39 of 43). At 24 months of follow-up, of the 16 patients initially included during the first year, a cure/improvement rate of 62.5% had been achieved (10 of 16). The first sensation of bladder filling had increased by the end of treatment, with differences observed before and after posterior tibial nerve stimulation (P ≤ .001). The average post-treatment bladder capacity had increased by 72.7 mL compared with the initial value (P ≤ .001). At 24 months of follow-up, the group of 16 patients evaluated recorded a significant worsening of night-time urination frequency (P ≤ .05) and quality of life (P ≤ .01). CONCLUSION: Posterior tibial nerve stimulation is a good option for the treatment of overactive bladder. In our series, the optimal point to start retreatment would be at 24 months after therapy completion.

Uretroplastia dorsal según técnica de Barbagli. Análisis de resultados y factores de éxito / Barbagli`s dorsal urethroplasty. Analysis of results and factors for success

OBJETIVO: La uretroplastia dorsal descrita por Barbagli ha ganado amplia aceptación en el tratamiento de la estenosis de uretra, dada la simplificación que otorga la obtención del injerto libre frente a los pediculados.Presentamos una serie de 50 casos intervenidos en nuestro servicio de estenosis de uretra mediante uretroplastia dorsal con injerto libre (técnica de Barbagli), asociado o no a otras tecnicas en estenosis mas complejas.MÉTODOS: La edad media de los pacientes ha sido de 48.8 años (23-77), el tiempo de seguimiento medio de 42.9 meses (12-96) y la etiología más observada ha sido la estenosis uretral inflamatoria (50%).RESULTADOS: La tasa global de éxito ha sido del 82% (41 casos) y la de fracaso 18% (9 casos). En el grupo de mayor seguimiento, se observa un leve descenso de la tasa de éxito del 80% (24 casos) sin que se aprecien diferencias entre ambos grupos (p=0.98).El análisis de las variables longitud del injerto (p=0.50; p>36=0.53), edad (p= 0.12; p>36=0.59), etiología de la estenosis (p=0.77; p>36=0.77) y tipo de injerto utilizado (p=0.24; p>36=0.38), no demostraron ejercer influencia alguna en el resultado final de la cirugía, tanto en el total de la muestra como en el subgrupo de seguimiento >36 meses.La localización de la estenosis en uretra bulbar ha demostrado mejor resultado funcional que los intervenidos por estenosis que afectaban además a otras zonas de la uretra (p= 0.001) manteniéndose dicho resultado en el grupo de mayor seguimiento (p>36=0.001).La ausencia de tratamiento previo a la cirugía uretral ha influenciado el éxito de la misma, ya que el 90.6% de pacientes sin tratamiento anterior a la uretroplastia han observado un buen resultado funcional frente al grupo de tratamiento previo a cirugía que lo ha obtenido en un 66.7% (p=0.03). Esta significación también se demuestra en el grupo de 36 meses (p>36 = 0.01)(AU)

CONCLUSIÓN: La uretroplastia dorsal con injerto libre es una técnica versátil y reproducible con unos resultados aceptables que permite su asociación a otras técnicas cuando la estenosis se extiende a la uretra peneana(AU)

OBJECTIVES: Dorsal urethroplasty as described by Barbagli has gained wide acceptance in the treatment of urethral stricture, given the simplification afforded by obtaining a free graft versus a flap.We present a series of 50 patients treated in our de-partment of urethral stricture by dorsal onlay free graft urethroplasty (Barbagli’s technique), in combination or not to other techniques in more complex strictures.METHODS: The average age of patients was 48.8 years (23-77), the mean follow up 42.9 months (12-96) and the most frequently observed etiology has been the inflammatory urethral stricture (50%).RESULTS: Overall success rate was 82% (41 cases) and failure 18% (9 cases). In the longer follow-up group, there was a slight drop in success rate of 80% (24 ca-ses) without any significant differences between groups (p= 0.98).Analyzing the variables length of free graft (p= 0.50, p> 36= 0.53), age (p= 0.12, p>36= 0.59), etiology of stricture (p= 0.77, p>36 = 0.77) and type of graft used (p=0.24, p>36= 0.38) did not show any influence on the final outcome of surgery, both in the total sample and the subgroup with follow-up > 36 months.The location of the stricture in bulbar urethra has shown better functional outcome than those operated on for stric-tures affecting also other urethral locations (p= 0.001) maintaining that result in the group of longer follow up (p>36= 0,001).The lack of treatment prior to urethral surgery has influen-ced the success of it, since 90.6% of patients without prior treatment before urethroplasty have seen a good func-tional outcome, compared to treatment prior to surgery that obtained a 66.7% (p= 0.03). This significance is also demonstrated in the group of follow-up > 36 months (p>36= 0.01)(AU)

CONCLUSION: The dorsal onlay free graft urethroplas-ty is a versatile and reproducible technique with accep-table results which allows combination with other tech-niques when the stenosis extends to the penile urethra. In exceptional cases of panurethral strictures secondary to lichen sclerosus when there is no significant spongiofi-brosis and an acceptable urethral plate, can be applied to the whole urethra(AU)

Hematocele gigante secundario a la ruptura de un hidrocele abdomino-escrotal / Hematocele secundary to rupture of an abdominoscrotal hydrocele

OBJETIVO: Presentación de un caso de hematocele secundario a un hidrocele abdomino escrotal en la edad adulta. MÉTODO Y RESULTADO: Presentamos el caso de un paciente que presentó este inusual tipo de hidrocele que tras un mínimo traumatismo escrotal ocasionó un importante hematocele. Se trata de un hidrocele que se extiende a través del canal inguinal hacia el espacio retroperitoneal, reseñando su aproximación diagnóstica así como el tratamiento quirúrgico. CONCLUSIONES: El hidrocele abdomino escrotal es una patología infrecuente en niños y lo es aún más en adultos. La presencia de un hematocele exige un tratamiento quirúrgico precoz (AU)

OBJECTIVE: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient. METHODS AND RESULTS: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space. CONCLUSIONS: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment (AU)

Litiasis múltiples en neovejiga tipo Hautmann / Multiple lithiasis in Hautmann neobladder

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Cuerpo extraño intraureteral / Intraurethral foreign body

No disponible