ABSTRACT
Objetivo Este estudio evalúa la seguridad y la eficacia del sistema Rezūm® en los pacientes con disfunción eréctil (DE) con y sin prótesis peneana inflable (PPI). Materiales y métodos Se trata de una revisión retrospectiva de los pacientes con DE tratados con Rezūm® por un único cirujano durante 12 meses. De cada paciente se obtuvo la edad, la presencia de PPI, el número de medicamentos para la hiperplasia prostática benigna, la puntuación internacional de síntomas prostáticos (IPSS), el índice de calidad de vida (QOL) de la IPSS, la tasa de flujo máximo (Qmáx) en la uroflujometría y la tasa de flujo promedio (Qavg) en la uroflujometría antes y después del tratamiento con Rezūm®. Se utilizaron pruebas T para 2 muestras independientes con objeto de comparar las características preoperatorias y postoperatorias entre los pacientes con y sin PPI. Se realizó una regresión lineal para identificar los factores asociados con el Qmáx o Qavg postoperatorio. Resultados Se identificaron un total de 17 pacientes con DE sometidos al sistema Rezūm®, incluyendo 11 pacientes con una PPI. La mediana de seguimiento tras el tratamiento con Rezūm® fue de 65 días. No hubo diferencias significativas en cuanto a los datos demográficos y las características clínicas basales entre los pacientes con y sin PPI. El Qmáx postoperatorio (10,9 frente a 9,8ml/s; p=0,04) y el Qavg (7,5 frente a 6,0ml/s; p=0,03) fueron significativamente mayores en los pacientes con PPI en comparación con los pacientes sin PPI. No hubo factores asociados con el Qmáx o el Qavg postoperatorio en la regresión lineal. Dos pacientes sin PPI resultaron en retención urinaria, mientras que en los pacientes con PPI no se produjeron complicaciones. Conclusión Rezūm® es un procedimiento seguro y eficaz para realizar en pacientes con DE, especialmente en aquellos con una PPI. Los pacientes con PPI pueden experimentar un incremento mayor en los parámetros de uroflujometría en comparación con los pacientes con DE sin PPI (AU)
Purpose This study evaluates the safety and efficacy of Rezūm in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). Materials and methods This was a retrospective review of ED patients who underwent Rezūm by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmáx), and uroflowmetry average flow rate (Qavg) before and after Rezūm were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmáx or Qavg. Results A total of 17 patients with ED who underwent Rezūm were identified, including 11 patients with an IPP. The median follow-up after Rezūm was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmáx (10.9ml/s vs. 9.8ml/s, P=.04) and Qavg (7.5ml/s vs. 6.0ml/s, P=.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmáx or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. Conclusion Rezūm is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP (AU)
Subject(s)
Humans , Male , Middle Aged , Aged , Erectile Dysfunction/surgery , Penile Prosthesis , Prostatic Hyperplasia , Treatment Outcome , Retrospective StudiesABSTRACT
Introducción y objetivos: El trasplante renal se asocia a un mayor riesgo de cáncer de vejiga; sin embargo, no existen directrices sobre el tratamiento del cáncer de vejiga tras el trasplante renal.Materiales y métodosSe realizó una revisión sistemática de la literatura utilizando PubMed y siguiendo las directrices PRISMA para identificar estudios relacionados con la prevalencia y la supervivencia del cáncer de vejiga después del trasplante de riñón. También se revisaron y discutieron los factores de riesgo y el tratamiento de la enfermedad en este contexto.ResultadosSe identificaron un total de 41 estudios publicados entre 1996 y 2018, que incluían datos primarios sobre el cáncer de vejiga después del trasplante de riñón. Se observó una marcada heterogeneidad en términos de la prevalencia del cáncer vesical, el tiempo hasta el diagnóstico, la prevalencia del cáncer vesical no músculoinvasivo/músculoinvasivo, y la supervivencia. Se identificaron 4 estudios, publicados entre 2003 y 2017, que incluían datos primarios sobre el cáncer de vejiga tratado con el bacilo de Calmette-Guérin (BCG) después del trasplante de riñón. La supervivencia libre de enfermedad, la supervivencia específica del cáncer y la supervivencia global, fueron similares entre los estudios de BCG (75-100%).ConclusionesLa exposición a carcinógenos causante de ERET, VBK y VPH, los agentes inmunosupresores y el estado de inmunosupresión probablemente contribuyen a un mayor riesgo de cáncer de vejiga después del trasplante renal. La enfermedad no músculoinvasiva debe tratarse con resección transuretral. (AU)
Introduction and objectives: Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation.Materials and methodsA systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed.ResultsA total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%).ConclusionsCarcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops. (AU)
Subject(s)
Humans , Adjuvants, Immunologic , Cystectomy , Kidney Transplantation/adverse effects , Urinary Bladder Neoplasms/epidemiology , Risk FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS: A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS: A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS: Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
