ABSTRACT
OBJECTIVE: To evaluate the effect of endoscopic surgery on sexual function in patients with upper urinary tract (UUT) lithiasis. MATERIAL AND METHODS: We conducted an observational, prospective, longitudinal study with a single cohort of cases undergoing ureteroscopy (URS), retrograde intrarenal surgery (RIRS), or endoscopic combined intrarenal surgery (ECIRS). Patients' sexual response was assessed with questionnaires in the 30 days prior to surgery, and at one and three months after surgery. The International Index of Erectile Function (IIEF-t) was used in male patients, and the Female Sexual Function Index (FSFI) was used in female patients. RESULTS: Seventy patients - 34 men and 36 women - completed the study. Among men, the IIEF-t did not show significant difference between baseline scores (64.1⯱â¯7.50) and those obtained at 3 months (63.8⯱â¯9.51), with a non-significant decrease (pâ¯=â¯0.054) at the first month (61.4⯱â¯10.4). Subdomains did not worsen at 3 months, and desire (IIEF-SD) improved from 7.3⯱â¯1.9 to 8.0⯱â¯1.8. Among women, the FSFI-t did not change significantly after surgery: baseline score (27.3⯱â¯4.1), 1-month score (26.8⯱â¯3.7) and 3-month score (27.5⯱â¯4.2). No subdomain worsened at the third month. CONCLUSION: Endoscopic surgery for UUT is a safe technique in both sexes with no negative effect on sexual function. There are no differences between the baseline IIEF-t and FSFI-t scores and those obtained at 3 months.
ABSTRACT
Contexto: Se pretende evaluar el conocimiento actual acerca del tratamiento del carcinoma de células renales (CCR) que afecta al injerto en los pacientes trasplantados de riñón. Adquisición de evidencia: Revisión de la literatura actual basada en el análisis de los casos publicados de cirugía conservadora de nefronas en el carcinoma de células renales que afecta al injerto renal. Síntesis de evidencia: Se han descrito 51 casos de nefrectomía parcial en injerto renal, con una supervivencia del injerto del 88% y un índice de recurrencia del 6%. La mayoría de los pacientes estaban asintomáticos al diagnóstico (75%) y el tamaño medio de las lesiones fue de 2,8cm. La técnica más utilizada fue la enucleación. El 77% de las pautas inmunosupresoras incluían ciclosporina A. Seis pacientes fueron tratados mediante radiofrecuencia y 2 recibieron crioablación percutánea, con una supervivencia del 100% de los injertos y un único caso de recidiva, que requirió segundo tratamiento. Conclusiones: La cirugía conservadora del parénquima renal es una opción terapéutica empleada ante CCR sobre injerto renal que consigue buen control oncológico y buena supervivencia del injerto. La modificación de la inmunosupresión con la supresión de ciclosporina A y la introducción de inhibidores de mTOR podría ser una medida adecuada en estos pacientes y merece futuras investigaciones (AU)
Purpose: To evaluate the new treatment strategies in renal cell carcinoma (RCC) that affects the graft in renal recipients. Acquisition of evidence: A literature review is made, analyzing all the published cases of conservative surgery in renal graft RCC. Synthesis of evidence: A total of 51 partial nephrectomies in renal graft patients have been described, with a graft survival rate of 88% and a recurrence rate of 6%. Most of the patients (75%) were asymptomatic at the time of diagnosis, and the mean lesion size was 2.8cm. Enucleation was the most frequent technique employed. 77% of all immunosuppressor regimens included cyclosporine A. Six patients with graft RCC were subjected to radiofrequency ablation and two patients underwent percutaneous cryoablation, with a single case of relapse and a graft survival rate of 100%. Conclusions: Nephron-sparing surgery is a good management option in renal graft RCC, affording good oncological control and graft survival. Modification of immunosuppression with the withdrawal of cyclosporine A and the introduction of mTOR inhibitors is an adequate measure in such patients (AU)
Subject(s)
Humans , Male , Female , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/surgery , Nephrectomy/methods , Nephrectomy , Cryosurgery/methods , Cryosurgery/trends , Cryosurgery , Radio Waves/therapeutic use , Organ Preservation Solutions/therapeutic use , Carcinoma, Renal Cell/physiopathology , Carcinoma, Renal CellABSTRACT
PURPOSE: To evaluate the new treatment strategies in renal cell carcinoma (RCC) that affects the graft in renal recipients. ACQUISITION OF EVIDENCE: A literature review is made, analyzing all the published cases of conservative surgery in renal graft RCC. SYNTHESIS OF EVIDENCE: A total of 51 partial nephrectomies in renal graft patients have been described, with a graft survival rate of 88% and a recurrence rate of 6%. Most of the patients (75%) were asymptomatic at the time of diagnosis, and the mean lesion size was 2.8 cm. Enucleation was the most frequent technique employed. 77% of all immunosuppressor regimens included cyclosporine A. Six patients with graft RCC were subjected to radiofrequency ablation and two patients underwent percutaneous cryoablation, with a single case of relapse and a graft survival rate of 100%. CONCLUSIONS: Nephron-sparing surgery is a good management option in renal graft RCC, affording good oncological control and graft survival. Modification of immunosuppression with the withdrawal of cyclosporine A and the introduction of mTOR inhibitors is an adequate measure in such patients.