Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada / Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy

Introducción y objetivos Evaluar el efecto de la prostatectomía radical y la edad en los resultados urodinámicos antes y después de la radioterapia de intensidad modulada administrada a pacientes con cáncer de próstata. Materiales y métodos La muestra incluyó a 40 pacientes con cáncer de próstata, 22 de los cuales habían sido sometidos a prostatectomía radical. Se midieron y compararon los parámetros urodinámicos antes y después de una media de 4,2 meses de radioterapia. La radioterapia externa se administró mediante técnicas de terapia de arco volumétrico modulado y de radioterapia de intensidad modulada. Resultados No se vieron cambios significativos en los parámetros de uroflujometría. En el caso de la cistomanometría los datos no mostraron un aumento de la incontinencia urinaria de esfuerzo secundaria, pero sí un incremento del 7% en la incontinencia urinaria de urgencia. Hubo cambios estadísticamente significativos en la reducción de la capacidad vesical, con un deseo miccional fuerte, con urgencia miccional y también en la presión del detrusor con un deseo miccional normal. Además, el estudio de presión/flujo reveló una reducción estadísticamente significativa del volumen de orina residual. Conclusiones El efecto de la prostatectomía y la edad varía según la evolución del estudio urodinámico. Hubo una reducción significativa del volumen de orina residual, así como de la presión del detrusor, con un deseo miccional normal en los pacientes sin prostatectomía y en aquellos menores de 75 años. Además de un aumento en la incontinencia de urgencia, también se produjo un empeoramiento significativo del resultado urodinámico de llenado vesical y una disminución de la capacidad vesical cistomanométrica, con un deseo miccional fuerte y urgencia miccional. Ninguno de estos factores se vio afectado por la edad o la prostatectomía (AU)

Introduction and objectives To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. Materials and methods The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. Results Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. Conclusions The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy (AU)

Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS: The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS: Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS: The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.

Nefrolitotomía micropercutánea: una nueva opción terapéutica para la litiasis renal pediátrica / Micropercutaneous nephrolithotomy. A new therapeutic option for pediatric renal lithiasis

Introducción: La nefrolitotomía micropercutánea es una evolución de la cirugía percutánea convencional en la que se accede al sistema pielocalicial mediante orificios de mínimo calibre. Su objetivo es la completa eliminación del cálculo, disminuyendo la morbilidad producida por la realización de trayectos percutáneos de mayor diámetro. Material y métodos: Presentamos la realización de una nefrolitotomía micropercutánea en una paciente de 14 años con litiasis renal de 35 mm de diámetro situada en la pelvis renal. La cirugía se realiza en posición supina de Valdivia modificada en Galdakao. Punción guiada por ultrasonidos y fluoroscopia. Se emplea la aguja 4,85 Charrière (Ch) del set de Microperc®, completando el procedimiento a través de la vaina 8 Ch. Lasertricia con láser Ho:YAG. Se deja catéter doble J al finalizar el procedimiento. Resultados: Tiempo quirúrgico de 170 min. Estancia hospitalaria de un día. Cólico renal a las 72 h resuelto con analgesia en domicilio (Clavien I). Reincorporación a la vida escolar al 5.° día. Retirada del catéter doble J a las 2 semanas. La paciente está asintomática al mes de la intervención, observándose en la ecografía abdominal un resto de 4 mm en el cáliz inferior. Conclusión: La nefrolitotomía micropercutánea es un nuevo paso adelante hacia la búsqueda de la menor invasividad en el tratamiento de la litiasis renal, siendo una técnica segura y efectiva en la población pediátrica, pudiendo ser realizada en decúbito supino en riñones ortotópicos. Futuros estudios y trabajos colaborativos ayudarán definir mejor sus indicaciones, a optimizar su técnica quirúrgica y a analizar su coste-efectividad comparada con otros tratamientos

Introduction: Micropercutaneous nephrolithotomy is an evolution from the conventional percutaneous surgery in which pyelocaliceal access is obtained through minimum bore holes. Its objective is the complete removal of the calculi, lowering the morbidity associated with larger bore percutaneous tracts. Materials and methods: We present the case of a micropercutaneous nephrolithotomy performed in a 14-year-old female patient with a 35 mm diameter kidney stone located in the renal pelvis. Surgery was performed in the Galdakao-modified supine Valdivia position. Puncture was done under ultrasound and fluoroscopic guidance. The 4.85 Ch needle of the Microperc® set was used, completing the procedure through the 8 Ch working shaft. Lasertripsy was done with the Ho:YAG laser. An indwelling double J stent was placed at the end of the procedure. Results: Operating time was 170 min. Hospital stay was one day. She suffered renal colic after 72 h, which was resolved with oral analgesic treatment at home (Clavien I). She returned to school on the fifth postoperative day. The double J was removed at two weeks. At one month of the surgery, the patient is asymptomatic, a 4 mm lower calyx residual stone being observed in the abdominal ultrasound. Conclusion: Micropercutaneous nephrolithotomy is a step forward toward the search for a less invasive kidney stone treatment. It is a safe and effective technique in the pediatric population, and it can be performed in the supine position, even in orthotropic kidneys. Future studies and collaborative works will help to better define its indications, to optimize its technique and to analyze its cost-effectiveness compared with other treatment options

Micropercutaneous nephrolithotomy. A new therapeutic option for pediatric renal lithiasis.

INTRODUCTION: Micropercutaneous nephrolithotomy is an evolution from the conventional percutaneous surgery in which pyelocaliceal access is obtained through minimum bore holes. Its objective is the complete removal of the calculi, lowering the morbidity associated with larger bore percutaneous tracts. MATERIAL AND METHODS: We present the case of a micropercutaneous nephrolithotomy performed in a 14-year-old female patient with a 35 mm diameter kidney stone located in the renal pelvis. Surgery was performed in the Galdakao-modified supine Valdivia position. Puncture was done under ultrasound and fluoroscopic guidance. The 4.85 Ch needle of the Microperc(®) set was used, completing the procedure through the 8 Ch working shaft. Lasertripsy was done with the Ho:YAG laser. An indwelling double J stent was placed at the end of the procedure. RESULTS: Operating time was 170 minutes. Hospital stay was one day. She suffered renal colic after 72 hours, which was resolved with oral analgesic treatment at home (Clavien I). She returned to school on the fifth postoperative day. The double J was removed at 2 weeks. At one month of the surgery, the patient is asymptomatic, a 4mm lower calyx residual stone being observed in the abdominal ultrasound. CONCLUSION: Micropercutaneous nephrolithotomy is a step forward towards the search for a less invasive kidney stone treatment. It is a safe and effective technique in the pediatric population, and it can be performed in the supine position, even in orthotropic kidneys. Future studies and collaborative works will help to better define its indications, to optimize its technique and to analyze its cost-effectiveness compared with other treatment options.