Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n=570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p>0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n=20), only 61% reported satisfactory sexual intercourse (p<0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p<0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p>0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

Carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en carcinoma de células renales: nuestra experiencia y revisión de la literatura / Peritoneal carcinomatosis after partial nephrectomy for renal cell carcinoma: Our experience and literature review

Objetivo: La carcinomatosis peritoneal asociada al carcinoma de células renales es una entidad infrecuente, normalmente asociada a grandes masas renales, siendo muy rara su presentación tras la cirugía de tumores renales localizados. Nuestro objetivo es revisar la literatura y analizar los factores implicados en el desarrollo de carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en tumores localizados.Material y métodos: Presentamos nuestra experiencia con 2 casos de carcinomatosis peritoneal tras cirugía parcial laparoscópica. Realizamos revisión de la literatura y analizamos los factores asociados al desarrollo de carcinomatosis peritoneal tras cirugía parcial laparoscópica en carcinoma de células renales.Resultados: Entre 2005-2018 en nuestro servicio fueron sometidos a nefrectomía parcial laparoscópica 225 pacientes por neoplasia renal localizada. Dos pacientes desarrollaron carcinomatosis peritoneal en el seguimiento, uno al año y medio de la cirugía y un segundo caso a los 7 años. Pocos casos de carcinomatosis peritoneal tras cirugías de neoplasia renal han sido descritos en la literatura, estando más frecuentemente asociados a grandes masas renales, con múltiples metástasis al diagnóstico, siendo el pronóstico infausto. Entre los factores implicados en su desarrollo pueden estar la diseminación de células tumorales durante la cirugía, la extensión tumoral directa o la metástasis por vía hematógena.Conclusiones: La carcinomatosis peritoneal tras nefrectomía parcial laparoscópica constituye un evento muy raro, pero que debe ser tenido en cuenta y, dado que es el único factor en el que podemos influir, extremar al máximo las precauciones durante el acto quirúrgico, siguiendo los principios oncológicos. (AU)

Objective: Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors.Material and methods: We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma.Results: Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition.Conclusions: Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles. (AU)

Peritoneal carcinomatosis after partial nephrectomy for renal cell carcinoma: Our experience and literature review.

OBJECTIVE: Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors. MATERIAL AND METHODS: We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma. RESULTS: Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition. CONCLUSIONS: Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles.

Utilidad de la ECMO sobre el injerto pulmonar disfuncionante en un modelo porcino estandarizado de trasplante unipulmonar / [Usefulness of ECMO on dysfunctional lung graft in a standardized porcine model of one-lung transplant]

Objetivo: Establecer un modelo de muerte encefálica y trasplante pulmonar y analizar el posible papel protector del oxigenador de membrana extracorpóreo (ECMO).Métodos: Se emplearon 20 cerdos hembras, 10 donantes y 10 receptoras. Las receptoras del Grupo A (n = 5) fueron sometidas a un trasplante unipulmonar izquierdo (Tx-UPI) sin ECMO. Las receptoras del Grupo B (n = 5) se sometieron a un Tx-UPI con ECMO venoarterial (ECMO-VA). Se recopilaron datos funcionales e histológicos en situación basal, a los 10 minutos de clampar el hilio derecho (Tiempo 1) y a las 2 horas (Tiempo 2). Se analizó la expresión proteica de marcadores de inflamación y de la ruta de hipoxia.Resultados: El modelo de muerte encefálica empleado, seguido de un tiempo de isquemia frío prolongado (20 horas) dio lugar a la aparición de un edema pulmonar severo. Tras el implante, 3 receptores del grupo A sobrevivieron hasta el Tiempo 2, falleciendo 2 por edema pulmonar masivo. Por el contrario, todos los animales del Grupo B sobrevivieron, siendo la PaO2 en ese momento de 462,72 mmHg. Hubo un incremento de la expresión de IL6, TNF, PCR, AC IX y el VEGF, así como un descenso en la expresión de IL8 y GLUT1, al usar la ECMO.Conclusiones: Se ha desarrollado un modelo porcino estandarizado y reproducible de muerte encefálica, que simula el proceso clínico de la donación pulmonar. Este modelo puede servir de plataforma para investigar posibles dianas terapéuticas. (AU)

Objective: Establish a model of brain death and lung transplantation and analyze the possible protective role of extracorporeal membrane oxygenation (ECMO).Methods: 20 female pigs were used, 10 donors and 10 recipients. Group A recipients (n = 5) underwent left-sided single- lung transplantation (LUCT-Tx) without ECMO. Group B recipients (n = 5) underwent ICU-Tx with venoarterial ECMO (VA-ECMO). Functional and histological data were collected at baseline, 10 minutes after clamping the right hilum (Time 1) and 2 hours (Time 2). Protein expression of inflammation markers and the hypoxia pathway was analyzed.Results: The brain death model used, followed by a prolonged cold ischemia time (20 hours) gave rise to the appearance of severe pulmonary edema. After implantation, 3 group A recipients survived until Time 2, with 2 dying from massive pulmonary edema. In contrast, all the animals in Group B survived, with PaO2 at that time being 462.72 mmHg. There was an increase in the expression of IL6, TNFα, CRP, AC IX and VEGF, as well as a decrease in the expression of IL8 and GLUT1, when using ECMO.Conclusions: A standardized and reproducible porcine model of brain death has been developed, which simulates the clinical process of lung donation. This model can serve as a platform to investigate possible therapeutic targets. (AU)

Controversias en el diagnóstico del carcinoma de células renales con trombosis venosa asociada / Controversies in the diagnosis of renal cell carcinoma with tumor thrombus

El diagnóstico y tratamiento del carcinoma de células renales asociado con trombosis venosa tumoral sigue suponiendo un reto en la actualidad, requiriendo de equipos multidisciplinares, fundamentalmente en niveles del trombo III y IV. Nuestro objetivo es la exposición de las distintas técnicas diagnósticas empleadas y de las controversias asociadas. Para ello se ha llevado a cabo una revisión de los artículos relacionados más relevantes entre enero del 2000 y agosto de 2020 en PubMed, EMBASE y Scielo. El continuo desarrollo tecnológico, ha permitido avanzar en su detección, en la aproximación del subtipo histológico y en la determinación del nivel del trombo tumoral. Independientemente de la técnica de imagen utilizada para su diagnóstico (TC, RMN, ETE, ecografía con contraste), es de vital importancia el tiempo transcurrido hasta su tratamiento con el fin de disminuir el riesgo de complicaciones, algunas de ellas fatales como la tromboembolia pulmonar. (AU)

Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism. (AU)

Description of the methodology for dosimetric quantification in treatments with 177Lu-DOTATATE. / Descripción de la metodología para la cuantificación dosimétrica en tratamientos con 177Lu-DOTATATE.

Implementation of dosimetry calculations in the daily practice of Nuclear Medicine Departments is, at this time, a controversial issue, partly due to the lack of a standardized methodology that is accepted by all interested parties (patients, nuclear medicine physicians and medical physicists). However, since the publication of RD 601/2019 there is a legal obligation to implement it, despite the fact that it is a complex and high resource consumption procedure. The aim of this article is to review the theoretical bases of in vivo dosimetry in treatments with 177Lu-DOTATATE. The exposed methodology is the one proposed by the MIRD Committee (Medical Internal Radiation Dose) of the SNMMI (Society of Nuclear Medicine & Molecular Imaging). According to this method, the absorbed dose is obtained as the product of 2factors: the time-integrated activity of the radiopharmaceutical present in a source region and a geometrical factor S. This approach, which a priori seems simple, in practice requires several SPECT/CT acquisitions, several measurements of the whole body activity and taking several blood samples, as well as hours of image processing and computation. The systematic implementation of these calculations, in all the patients we treat, will allow us to obtain homogeneous data to correlate the absorbed doses in the lesions with the biological effect of the treatment. The final purpose of the dosimetry calculations is to be able to maximize the therapeutic effect in the lesions, controlling the radiotoxicity in the organs at risk.

Controversies in the diagnosis of renal cell carcinoma with tumor thrombus. / Controversias en el diagnóstico del carcinoma de células renales con trombosis venosa asociada.

Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.

PET/CT with 18F-Fluordesoxyglucose in patients with suspected endovascular prosthesis infection. / PET/TC con 18F-Fluordesoxiglucosa en pacientes con sospecha de infección de prótesis endovasculares.

OBJECTIVE: Infection of large vessel prostheses is a rare but critical complication. The aim of this work is to assess the impact of PET/CT with 18F-Fluordesoxyglucose (PET-FDG) on the diagnosis of infection in our environment. MATERIAL AND METHODS: Thirty-five patients (38 scans) were evaluated for suspected prosthetic infection. A qualitative analysis was performed taking into account the distribution of the radiopharmaceutical, categorizing the studies as positive or negative for infection. Those with focal or multifocal deposits along the vascular prosthesis were considered positive, and negative if a homogeneous and diffuse distribution over the whole prosthesis was observed, or a total absence of uptake. A semi-quantitative analysis was performed using SUVmax and average SUV values, and a metabolic index was calculated (SUVmax of the graft / average SUV of the normal vascular pool). RESULTS: The PET-FDG study was positive in 20 patients, with a diagnostic accuracy of 84%. The 38 PET-FDG scans performed showed positive capture patterns (focal in 6, multifocal in 15, diffuse in 4) and negative pattern in the remaining 13. The sensitivity, specificity, positive and negative predictive values obtained for the PET-FDG were 95%, 89%, 90% and 94%, and for the AngioTC study 50%, 73%, 73% and 50%, respectively. The area values under the ROC curve were as follows: for the AngioTC 0.642 (not significant), and for the SUVmax values of 0.925 (p<0.005), average SUV of 0.922 (p<0.005) and for the metabolic index of 0.917 (p<0.005). CONCLUSIONS: The PET-FDG proves to be a tool with high diagnostic accuracy in the infection of vascular prosthesis, both visual analysis according to patterns and semi-quantitative.

Ganglioneuroma dependiente del nervio frénico: localización inusual / Ganglioneuroma of the Phrenic Nerve: An Unusual Site

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Surgical implant options in patients with penile fibrosis due to infection or previous explants. / Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos.

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.