Manejo del paciente neurourológico durante la pandemia COVID-19 / Management of neurourological patients during the COVID-19 pandemic

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing ther ecommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

AIMS: The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. DESIGN: Cross sectional survey. SUBJECT AND METHODS: The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. RESULTS: The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). CONCLUSIONS: According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

Tratamiento quirúrgico en un caso de linfedema escrotal / Surgical treatment in a case of giant scrotal lymphedema

OBJETIVO: El linfedema escrotal (LE) es una patología rara en nuestro medio. Presentamos un caso de linfedema escrotal gigante y realizamos una revisión bibliográfica de la literatura existente en la base de datos Medline en los últimos 10 años.MÉTODO: Presentamos el caso de un varón con linfedema escrotal gigante (43x 40 Cm.), de cuatro años de evolución y de etiología incierta.RESULTADO: Fue tratado quirúrgicamente, mediante exéresis completa escrotal y reconstrucción mediante injertos cutáneos, con resultado exitoso.CONCLUSIONES: El LE es una entidad rara, sobre todo en países industrializados. Independientemente de la causa, si el linfedema es severo, el tratamiento quirúrgico es la opción terapéutica más adecuada. La resección completa hasta tejido sano y la reconstrucción quirúrgica es el tratamiento de elección, cuando afecta a todo el escroto, siendo necesario el uso de injertos cutáneos de piel fina para su reconstrucción(AU)

OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology with multiple etiologies. We report a case of idiopathic giant scrotal lymphedema and review the existing medical literature in Medline from the last ten years.METHODS: We report the case of a male patient with a giant scrotal lymphedema (43x 40 cm) of unknown etiology developed over four years.RESULTS: The patient was treated by scrotal excision and reconstruction with skin graft plasty, with a successful result.CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in industrialized countries. If the lymphedema is severe, surgery is the most appropriate therapeutic option, whatever the cause is. Complete resection up to healthy tissue and surgical reconstruction is the choice. Thin skin grafts are necessary for reconstruction when it affects the entire scrotum(AU)

Sertoli cell tumor, a rare testicular tumor, our experience and review of the literature.

OBJECTIVE: We report two new cases of Sertoli cell testicular tumors, and a Cochrane and Medline search of cases published worldwide. METHODS: We reviewed our series of testicular tumors, the stromal tumor incidence, clinical presentation, treatment and prognosis, and the experience reflected in the literature. RESULTS: The prevalence of testicular tumors in our health area is of 0.09%, and 2.3% of them are Sertoli cell neoplasms. This figure is slightly higher than the found in other series in which Sertoli tumors range from 0.4% to 1.5% of testicular malignancies in adults and reach 4% in children. CONCLUSIONS: Sertoli cell tumor has an incidence not exceeding 4%. The most common symptom is a painless mass; in cases with endocrine manifestation, up to 10% are malignant depending on the age of the patient.

Tumor de células de sertoli. Un extraño tumor testicular. Nuestra experiencia y revisión de la literatura / Sertolli cell tumor, a rare testicular tumor, our experience and review of the literature

OBJETIVO: Aportamos dos nuevos casos de tumor testicular de células de Sertoli, realizando búsqueda en Medline y Cochrane de los casos publicados a nivel internacional.MÉTODOS: Revisión de nuestra serie de neoplasias testiculares, incidencia de los tumores estromales, presentación, clínica, tratamiento y pronóstico, así como de la experiencia reflejada en la literatura. RESULTADOS:La prevalencia de los tumores testiculares en nuestra área de salud es del 0,09 %, suponiendo el tumor de Sertoli el 2,3 % de ellos. La incidencia es levemente superior a la informada en otros trabajos, con cifras del 0,4% al 1,5% de los tumores testiculares en el adulto y hasta el 4% en los niños. La presentación más habitual es la masa testicular indolora, pudiendo existir semiología secundaria a la producción hormonal.CONCLUSIONES: El tumor de células de Sertoli presenta una incidencia no superior al 4% de las neoplasias testiculares. La clínica más habitual es la tumoración indolora, existiendo casos de manifestaciones endocrinas que varían según la edad del paciente Hasta un 10% de ellos se comportan de manera maligna(AU)

OBJECTIVE: We report two new cases of Sertoli cell testicular tumors, and a Cochrane and Medline search of cases published worldwide.METHODS: We reviewed our series of testicular tumors, the stromal tumor incidence, clinical presentation, treatment and prognosis, and the experience reflected in the literature.RESULTS: The prevalence of testicular tumors in our health area is of 0.09%, and 2.3% of them are Sertoli cell neoplasms. This figure is slightly higher than the found in other series in which Sertoli tumors range from 0.4% to 1.5% of testicular malignancies in adults and reach 4% in children.CONCLUSIONS: Sertoli cell tumor has an incidence not exceeding 4%. The most common symptom is a painless mass; in cases with endocrine manifestation, up to 10% are malignant depending on the age of the patient