Enucleación prostática con láser de holmio (HoLEP) mediante cirugía sin ingreso: una alternativa posible y segura / Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option

Objetivo Estudiar la viabilidad de la enucleación prostática con láser de holmio (HoLEP) en circuito de cirugía mayor ambulatoria. Material y métodos Se realiza un estudio prospectivo observacional en el que se incluyen 25 pacientes intervenidos de HoLEP que han sido dados de alta el mismo día de la cirugía según criterios previamente establecidos. Resultados La edad media de los pacientes intervenidos fue de 65,1 años. El volumen prostático medio fue de 45,8cc. Todos los pacientes fueron dados de alta el día de la cirugía (alta efectiva 100%). El porcentaje de complicaciones en nuestra serie fue del 12%, todas ellas grado I según la Clasificación Clavien Dindo. Ningún paciente precisó reingreso en los 30 días posteriores al procedimiento. El porcentaje de satisfacción con el circuito de cirugía ambulatoria fue del 95%. Conclusiones Tras el análisis inicial de nuestros datos podemos concluir que el HoLEP ambulatorio es una técnica eficaz y segura con bajo riesgo de complicaciones. El circuito de cirugía ambulatoria es el preferido por los pacientes intervenidos de HoLEP (AU)

Objective To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. Material and methods Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. Results The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. Conclusions The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP (AU)

Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option.

OBJECTIVE: To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS: Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS: The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS: The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.

Profilaxis antibiótica "dirigida" por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria / Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs

Introducción: La biopsia prostática transrectal ecográficamente dirigida (BPTE) se asocia a complicaciones infecciosas (CI). Las CI están relacionadas con un incremento de la prevalencia de bacterias ciprofloxacino-resistentes (BCR) en la flora rectal. Estudiamos las CI ocurridas en 2 grupos. Grupo de profilaxis antibiótica «dirigida» (GPD) vs. grupo de profilaxis empírica (GPE). Evaluamos el impacto económico que supone la profilaxis antibiótica «dirigida» (PD). Material y métodos: El GPD se estudió prospectivamente (junio 2013-julio 2014). Se recogieron cultivos rectales (CR) antes de BPTE y se sembraron en medios selectivos con ciprofloxacino para determinar la presencia de BCR. Los pacientes con bacterias sensibles recibieron ciprofloxacino. Pacientes con bacterias resistentes recibieron PD según antibiograma del CR. El GPE se estudió retrospectivamente (enero 2011-junio 2009). El CR no se realizó y todos los pacientes recibieron ciprofloxacino como profilaxis. Las CI ocurridas en ambos grupos se registraron en un periodo no superior a 30 días después de BPTE (historia clínica electrónica). Resultados: Trescientos pacientes fueron sometidos a BPTE, 145 recibieron PD y 155 PE. En el GPD, 23 pacientes (15,86%) presentaron BCR en CR. Solo un paciente (0,7%) experimentó ITU. En el GPE, 26 pacientes (16,8%) experimentaron múltiples CI (incluidas 2 sepsis) (p < 0,005). El coste total estimado, incluido el manejo de las CI, fue de 57.076 € con PE vs. 4.802,33 € con PD. El coste promedio/paciente con PE fue de 368,23 € vs. 33,11 € con PD. La PD logró un ahorro total estimado de 52.273,67 €. Es necesario que 6 pacientes se sometan a PD para prevenir una CI. Conclusiones: La PD se asoció a un notable descenso de la incidencia de CI causadas por BCR y redujo los costos de atención sanitaria

Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP.: Material and methods: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Results: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P < .005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was € 368.23 versus €33.11 with GP. GP achieved an estimated total savings of € 52,273.67. Six patients had to undergo GP to prevent an IC. Conclusions: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs

Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs. / Profilaxis antibiótica «dirigida¼ por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. MATERIAL AND METHODS: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). RESULTS: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. CONCLUSIONS: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs.

Implantación laparoscópica de esfínter urinario artificial: una opción en el tratamiento de la incontinencia urinaria femenina recidivada / Laparoscopic implantation of artificial urinary sphincter: An option for treating recurrent female urinary incontinence

Introducción: El fallo de la cirugía anti-incontinencia oscila entre el 5-80%. En la actualidad no existe consenso sobre el uso del esfínter urinario artificial (EUA) como tratamiento de la incontinencia urinaria recidivada en la mujer. Varios autores han demostrado que el EUA es útil si se comprueba la deficiencia intrínseca del esfínter. Presentamos, a nuestro entender, el primer caso descrito en España sobre la implantación laparoscópica de un EUA como tratamiento de la incontinencia urinaria recidivada femenina. Material y métodos: Bajo anestesia general se colocó a la paciente en decúbito supino con ligero Trendelenburg y se comprobó el acceso a la vagina. Mediante un abordaje laparoscópico pélvico transperitoneal se desarrolló el espacio de Retzius y seguidamente los espacios laterovaginales hasta la fascia endopélvica. Para facilitar la disección del cuello vesical se introdujo una torunda en la vagina, realizando maniobras simultáneas de tracción y contratracción. Como puerta de entrada para el EUA se amplió la incisión del trocar inferior. Se ajustó el manguito periuretral y seguidamente se colocan: el reservorio y la bomba en el espacio latero-vesical y el labio mayor de la vulva respectivamente. Finalmente, se conectaron los 3 elementos del EUA y se cerró el peritoneo para aislarlo del intestino. Resultados: Tiempo operatorio: 92 min. Pérdida hemática estimada < 100 cc3. Estancia hospitalaria: 48 h. No ocurrieron complicaciones intra ni postoperatorias. El EUA se activó a las 6 semanas. A los 24 meses la paciente lo manipula adecuadamente y alcanzó continencia total. Conclusiones: La implantación laparoscópica del EUA es una técnica factible. Las maniobras transvaginales de tracción y contratracción pueden evitar lesiones intraoperatorias

Introduction: The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence. Material and methods: Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine. Results: The surgical time was 92 min, the estimated blood loss was < 100 cc3 and the hospital stay was 48 h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved. Conclusions: Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions

Laparoscopic implantation of artificial urinary sphincter: An option for treating recurrent female urinary incontinence. / Implantación laparoscópica de esfínter urinario artificial: una opción en el tratamiento de la incontinencia urinaria femenina recidivada.

INTRODUCTION: The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence. MATERIAL AND METHODS: Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine. RESULTS: The surgical time was 92min, the estimated blood loss was <100cc(3) and the hospital stay was 48h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved. CONCLUSIONS: Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions.

Diagnostic detection of Streptococcus pneumoniae PpmA in urine.

Streptococcus pneumoniae infections are often difficult to diagnose accurately, as it is not uncommon for clinical samples to be culture-negative, particularly after antibiotic administration. The rapid Binax NOW S. pneumoniae urinary antigen test lacks specificity in children, owing to pneumococcal antigen reactions in children who are nasopharyngeal carriers of S. pneumoniae. A western blot assay with a specific polyclonal antibody was developed for direct detection of the putative proteinase maturation protein A (PpmA) in urine samples from children with pneumococcal infections. The sensitivity and specificity of the assay were 66.7% and 100%, respectively. Previous antibiotic treatment or S. pneumoniae nasopharyngeal colonization did not affect PpmA antigenuria. Results also demonstrated the presence of PpmA cross-reactive epitopes in commensal bacteria that co-colonize the nasopharyngeal niche, although the non-pneumococcal cross-reactive protein(s) did not interfere with the detection assay. S. pneumoniae PpmA in the urine of children with pneumococcal infections may be a marker that has the potential to be used in the clinical diagnosis of pneumococcal infection.

[Neuropathies due to vasculitis in infancy]. / Neuropatias por vasculitis en la infancia.

INTRODUCTION: Vasculitis are characterised by the inflammatory infiltrate, chiefly of mononuclear cells, in the walls of the blood vessels, which can lead to occlusion with necrosis and the subsequent infarction of the affected tissue. AIMS: The Objective of this study was to determine the clinical, anatomicopathological and neurophysiological aspects of vasculitic neuropathies in infancy. PATIENTS AND METHODS: Each patient was submitted to the following tests: a complete hemogram, systemic lupus erythematosus cells (LE cells), lupus anticoagulant, antinuclear antibodies, neutrophil anticytoplasmic antibodies, venereal disease research laboratory test (VDRL), erythrocyte sedimentation rate, liver transaminases, serological testing for hepatitis C, B and A, cytochemical study of the cerebrospinal fluid, study of motor and sensory conduction, electromyography and nuclear magnetic resonance, when required; a biopsy of the sural nerve was performed, which was replaced by a necropsy if the patient died. RESULTS: 15 patients from a total of 25 who were studied had vasculitic neuropathies; the most usual presentation was multiple mononeuropathy; aetiologies found included microscopic polyangiitis, systemic lupus erythematosus, JRA, overlap syndrome and several undetermined vasculitis. Of the patients who were submitted to a biopsy, 75% showed signs of vasculitis, which affected the small and medium sized vessels in 62.5% of patients. CONCLUSIONS: The presence of neuropathy in association with symptoms and signs of systemic involvement suggested the possibility of a neuropathy in the course of a vasculitis. The examination of biopsy specimens of the sural nerve is useful for the diagnosis and classification of the aetiology of vasculitis. Response to treatment with immunosuppressant drugs was good, both in the case of the neuropathy and of the underlying disease.

Neuropatías por vasculitis en la infancia / Neuropathies due to vasculitis in infancy

Introducción. Las vasculitis se caracterizan por el infiltrado inflamatorio, predominantemente de células mononucleares, de la pared de los vasos sanguíneos, que pueden llevar a la oclusión con necrosis y el consiguiente infarto del tejido afectado. Objetivo. Conocer los aspectos clínicos, anatomopatológicos y neurofisiológicos de las neuropatías vasculíticas en la infancia. Pacientes y métodos. A cada paciente se le realizó: hemograma completo, células del lupus eritematoso sistémico, anticoagulante lúpico, anticuerpos antinucleares, anticuerpos anticitoplasmáticos de neutrófilos, prueba de laboratorio para la investigación de enfermedades venéreas, velocidad de sedimentación globular, transaminasas hepáticas, serología para hepatitis C, B y A, estudio citoquímico del líquido cefalorraquídeo, estudio de la conducción motora y sensitiva, electromiografía y resonancia magnética nuclear, cuando fue necesario; se realizó una biopsia del nervio sural y una necropsia, si el paciente falleció. Resultados. 15 pacientes de un total de 25 estudiados tenían neuropatías vasculíticas; la presentación más usual fue la mononeuropatía múltiple; dentro de las etiologías se encontraron poliangitis microscópica, lupus eritematoso sistémico, artritis reumatoide juvenil, síndrome de solapamiento y vasculitis indeterminadas. De los pacientes biopsiados, el 75 por ciento mostraba signos de vasculitis, que afectaban a los vasos medianos y pequeños en el 62,5 por ciento de los pacientes. Conclusiones. La presencia de neuropatía en asociación con síntomas y signos de afectación sistémica nos orientó hacia la posibilidad de la existencia de neuropatía en el curso de una vasculitis. La biopsia del nervio sural es útil para el diagnóstico y la clasificación de la etiología de la vasculitis. Existió una buena respuesta al tratamiento, tanto de la neuropatía como de la enfermedad de base, con inmunosupresores (AU)

A rearranged genomic segment 11 is common to different human rotaviruses.

Gene 11 of human rotaviruses with short electropherotype, independently obtained from infected children in Argentina, have an insertion of 148 nt in the 3' untranslated region. All viruses were highly homologous among them and with two others human strains, DS-1 and RV5.