Optimisation of sonourethrography: the clamp method.

PURPOSE: To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults. MATERIALS AND METHODS: Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test. RESULTS: RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min. CONCLUSION: The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy). KEY POINTS: • The clamp method enables RSUG to be performed simply and painlessly. • The clamp method requires only one operator and allows assessing urethromeatal alterations. • RSUG shows greater capacity for detecting anterior urethral strictures than RUG. • The clamp method achieves retrograde bladder filling in approximately 6 min. • CE-VSUG shows greater capacity for detecting strictures than VCUG.

[Clinic-pathologic pattern and survival range in resectable gastric carcinoma]. / Cuadro Clínico Patológico y sobrevida en Carcinoma Gástrico Operable.

The present retrospective study evaluated 180 patients with resectable (Group I ) and 128 patients with unresectable (Group II) gastric carcinoma at Belen Hospital, Trujillo, Peru, from 1966 to 1998, with the aim to identify the clinical and pathological features, actuarial survival rate and surgical morbidity and mortality rates of both groups. The mean age of the total series was of 58.3 + 14.8 years (range, 18 to 85 years). The most frequent symptoms in both groups were abdominal pain (89.4% and 94.5% respectively) and the most common sign was pallor (62.8% and 54.5% respectively). The unresectable cases presented a higher frequency of palpable mass (p<0.001), upper two thirds neoplasms (p=0.0032), T4 lesions (p<0.001), distant metastasis (p<0.001), stage IV (p<0.001), hepatic metastasis (p<0.001) and peritoneal metastasis (p<0.001), compared with resectable gastric cancer patients. The total surgical mortality rate was of 19.5% (Group I: 12.1%, Group II: 28.9%). The most frequent complications were pneumonia (Group I: 8.9%, Group II: 7.8%) and surgical wound infection (Group I: 10.6%, Group II: 3.9%). In Group II, the exploratory laparotomy was carried out in 82 cases, whilst 46 cases underwent gastroenterostomy (n=34), gastrostomy (n=6), gastrectomy by exclusion (n=5) and ileotransversoanastomosis (n=1). The 5-year survival rate in resectable patients was of 18.5% and in unresectable cases the survival rate at 12 and 36 months was of 9% and 0% respectively. The early diagnosis of this neoplasm, mainly in high risk patients, would offer better possibilities of an opportune treatment.

[EXTENDED LYMPHA DENECTOMY SURVIVAL EFFICACY IN PATIENTS WITH ADVANCED GASTRIC CARCINOMA] / Eficacia de la linfadenectomía extendida en la sobrevida de pacientes con carcinoma gástrico avanzado.

OBJECTIVES: Determine the 5-year survival rate, prognostic factors, postoperative morbidity and mortality rates and the accuracy of the Maruyama computer program.MATERIAL and METHODS: This prospective study evaluated 32 patients with advanced gastric adenocarcinoma underwent radical gastrectomy with D2 (n= 13) or D3-D4 (n= 19) extended lymphadenectomy, at Belen Hospital, Trujillo, Peru, from 1990 to 1998.RESULTS: Gastric cancer patients (20 F: 12 M) had a median age of 55.4 + 14.5 years (range, 20 to 76 years). In D3-D4 patients there was a significant increased in the number of cases with lesions type Borrmann III-IV (p= 0.03), N3 (p= 0.04), M1 (p= 0.04) and undifferentiated type in histology (p= 0.04) compared with D2 cases. The 5-year survival in curative and palliative surgery was of 48.9% and 10.7%, respectively (p<0.001). The 5-year survival in D2 surgery was of 42.7% and in D3-D4 was of 27.6% (p= NS). The 5-year survival rate in the total series was of 30.9%. Location (p< 0.05) and size of the tumor (p< 0.01), distant metastases (p< 0.05), clinical stage (p< 0.05), Borrmann's type (p< 0.05) and curability (p< 0.05) were factors that influenced long-term survival. The morbidity rate with D2 and D3-D4 disection was of 30.7% and 57.8%, respectively (p= NS), and in the total series was of 46.8%. The mortality rate in this series was of 3.1%. The prediction of the lymphs node metastases with the computer program was highly exact (13-16: 100%, 7-12: 75%, 1-6: 66%).CONCLUSIONS: Extended lymphadenectomy had a low surgical mortality but high morbidity and permitted that one third of advanced gastric cancer patients underwent surgery obtains 5-year survival.