Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy.

OBJECTIVE: The study aimed to test the hypothesis that the instillation of lidocaine gel does not reduce the pain related to flexible cystoscopy. MATERIAL AND METHODS: A prospective randomized study was designed to compare the pain perception between intraurethral instillation of lidocaine gel and saline solution in flexible cystoscopy. One hundred consecutive male patients attending for flexible cystoscopy were randomized to receive 10 ml of lidocaine gel or 10 ml of saline solution. Saline solution was also used for the irrigation pressure. Patients recorded their pain on a 10 cm Visual Analog Scale before and after the procedure. Patients also assessed whether the cystoscopy was more painful than the previous one. Statistical comparison was made using the t test for parametrical data and the Mann-Whitney U test for non-parametrical data. RESULTS: Mean pain score in the lidocaine group was 0.67 ± 1.11 cm (range 0-5) compared to 0.55 ± 1.10 cm (range 0-5) in the saline solution group. Pain perception did not differ significantly between the 2 groups (mean difference 0.12 cm, 95% CI -0.32 to 0.55, p = 0.40). CONCLUSIONS: Prior lubrication of the urethra does not reduce the pain produced during flexible cystoscopy. The introduction of flexible cystoscopes under direct vision and with an irrigation pressure might guarantee sufficient comfort and the lubricant gel instillation could be avoided.

[Robotic kidney transplantation.] / Trasplante renal robótico.

OBJECTIVE: Renal transplant surgery has not undergone any major changes until a few years ago, probably due to the technical difficulty involved in performing a laparoscopic transplant. With the introduction of robotic technology, the difficulties derived from laparoscopic surgery in certain procedures have been reduced, so we can now offer a minimally invasive approach to kidney recipients. METHODS: Review of published literature on robotic kidney transplantation. RESULTS: Since the first robot-assisted renal transplantation in 2009, several hundred cases have been performed. The different series of published cases, although with different surgical techniques, show initial functional results comparable to conventional open surgery. Despite this evidence, there are no comparative quality studies that confirm this hypothesis. CONCLUSIONS: Robotic renal transplantation is a feasible surgical technique with interesting functional results. As a minimally invasive route, it is a promising option to reduce the surgical morbidity inherent to the renal transplant.

Tratamiento antioxidante en hombres con infertilidad idiopática / Antioxidant treatment in men with idiopathic infertility

Objetivo. Los espermatozoides son vulnerables al estrés oxidativo, lo que ha llevado al uso de antioxidantes en hombres con infertilidad idiopática. Nuestro objetivo fue analizar los resultados del tratamiento antioxidante en hombres con infertilidad idiopática. Material y métodos. Estudio retrospectivo de 133 hombres con infertilidad idiopática que consultaron nuestro servicio entre 2010 y 2014. Evaluamos el número total de espermatozoides (NTE), formas progresivas (PR) y formas normales (FN) previo a tratamiento, tras 3 meses de tratamiento antioxidante y tras 3 meses más de tratamiento. Este consistió en ácido docosahexaenoico, coenzima Q10, zinc y selenio. Valoramos también la FSH e inhibinaB pretratamiento. Se utilizó el test de Wilcoxon para comparar los parámetros seminales antes y después del tratamiento y el coeficiente de correlación de Spearman para analizar la correlación entre variables pretratamiento y mejoría seminal. Resultados. La edad fue de 36,8±5,1 años y los valores de inhibinaB y FSH, de 128,5±66ng/l y 7±7U/l, respectivamente. Había 35 (26,3%) oligozoospérmicos, 99 (74,4%) astenospérmicos y 23 (17,2%) teratospérmicos. Encontramos mejoría significativa en el NTE, las PR y las FN tras 3 meses de antioxidantes respecto a los valores pretratamiento. Valores pretratamiento más bajos de NTE, PR y FN se correlacionaron con una mayor mejoría en el NTE (rs: −0,31; p=0,004), PR (rs: −0,27; p=0,002) y FN (rs: −0,48; p<0,001), respectivamente. No hubo correlación entre los valores hormonales y los resultados del tratamiento. Conclusiones. Los hombres con infertilidad idiopática pueden beneficiarse de 3 meses de tratamiento antioxidante. Aquellos con mayores alteraciones en el seminograma podrían obtener un mayor beneficio del tratamiento (AU)

Objective. Spermatozoa are susceptible to oxidative stress, which has lead to the use of antioxidants in men with idiopathic infertility. Our objective was to analyze results of antioxidant treatment in men with idiopathic infertility. Material and methods. Retrospective study of those 133 consecutive men with idiopathic infertility who attended our department between 2010-2014. We collected data about total sperm number (TSN), progressive forms (PF) and normal forms (NF) previous to treatment, after 3 months of antioxidant treatment and after 3 more months of treatment. We also assessed FSH and inhibinB levels before treatment. Antioxidant treatment was based on docosahexaenoic acid, coenzyme Q10, zinc and selenium. Wilcoxon test for paired samples was performed to compare semen parameters before and after treatment and Spearman's rank correlation coefficient to analyze any correlation between pretreatment variables and seminal improvement. Results. Mean age was 36.8±5.1 years. InhibinB and FSH values were 128.5±66ng/l and 7±7U/l, respectively. There were 35 (26.3%) oligozoospermic, 99 (74.4%) asthenospermic and 23 (17.2%) teratospermic patients. We found significant improvement in TSN, PF and NF after 3 months compared to before treatment. Lower pretreatment levels of TSN, PF percentage and NF percentage significantly correlated with a greater improvement of TSN (rs: −0.31; p=0.004), PF percentage (rs: −0.27; p=0.002) and NF percentage (rs: −0.48; p<0.001), respectively. No correlation was found between pretreatment hormonal values and results of treatment. Conclusions. Men with idiopathic infertility can benefit from 3 months of antioxidants. Those with greater deficiencies in sperm analysis could benefit the most from treatment (AU)

Trasplante renal robótico / Robotic kidney transplantation

OBJETIVO: La cirugía del trasplante renal no ha sufrido ningún cambio importante hasta hace pocos años, probablemente debido a la dificultad técnica que conlleva el realizar un trasplante laparoscópico. Con la introducción de la tecnología robótica, la dificultad técnica derivada de la cirugía laparoscópica en ciertos procedimientos se ha visto reducida, por lo que actualmente podemos ofrecer un abordaje mínimamente invasivo para la realización de un trasplante renal. En este artículo realizamos una revisión de la literatura sobre el trasplante renal robótico. MÉTODOS: Revisión de la literatura publicada sobre trasplante renal robótico. RESULTADOS: Desde la realización del primer trasplante renal asistido por robot en 2009, se han realizado varios centenares de casos. Las distintas series de casos publicadas, aunque con diferentes técnicas quirúrgicas, muestran unos resultados funcionales iniciales comparables a la cirugía abierta convencional. A pesar de ello, no existen estudios comparativos de calidad que nos confirmen esta hipótesis. CONCLUSIONES: El trasplante renal robótico es una técnica quirúrgica factible con unos resultados funcionales correctos. El hecho de proporcionar una vía poco invasiva hace que sea una opción prometedora para disminuir la morbilidad quirúrgica propia del trasplante renal

OBJECTIVE: Renal transplant surgery has not undergone any major changes until a few years ago, probably due to the technical difficulty involved in performing a laparoscopic transplant. With the introduction of robotic technology, the difficulties derived from laparoscopic surgery in certain procedures have been reduced, so we can now offer a minimally invasive approach to kidney recipients. METHODS: Review of published literature on robotic kidney transplantation. RESULTS: Since the first robot-assisted renal transplantation in 2009, several hundred cases have been performed. The different series of published cases, although with different surgical techniques, show initial functional results comparable to conventional open surgery. Despite this evidence, there are no comparative quality studies that confirm this hypothesis. CONCLUSIONS: Robotic renal transplantation is a feasible surgical technique with interesting functional results. As a minimally invasive route, it is a promising option to reduce the surgical morbidity inherent to the renal transplant