¿Linfedema escrotal? A propósito de un caso / Scrotal lymphedema? Report of a case

Presentamos el caso y la evolución de un paciente obeso mórbido con antecedentes de dermolipectomía que acudió al Servicio de Urología por iniciativa propia a raíz un cuadro clínico de aumento de volumen escrotal que simulaba un linfedema escrotal con pene umbilicado. Después de realizar los estudios complementarios se asocia el cuadro clínico a los antecedentes quirúrgicos y se decide realizar la exéresis del tejido afecto y una cirugía reparadora junto con el servicio de Cirugía Plástica. El informe de Anatomía Patológica describe un angiomixoma benigno. En este contexto exponemos el caso de un paciente diagnosticado de linfedema escrotal que escondía un angiomixoma (AU)

We report the evolution of a morbidly obese patient with a history of dermolipectomy who attended the Urology Department because of an enlargement of the scrotum and penis. After performing additional studies, the cause is attributed to his surgical history and it was decided to perform the excision of the affected tissue and a reconstructive surgery. The pathology report revealed a benign angiomyxoma. In this context we describe the case of a patient diagnosed with scrotal lymphedema that hid a angiomyxoma (AU)

Calidad de Vida en pacientes con hiperplasia benigna de próstata (HBP): cirugía endoscópica (RTU bipolar) versus cirugía láser (LBO 120 W) / Quality of life of patients with benign prostatic hyperplasia (BPH): endoscopic surgery versus laser therapy

OBJETIVO: Contrastar los resultados observados en la calidad de vida de los pacientes intervenidos mediante resección transuretral de próstata (RTU bipolar) o mediante la cirugía láser. MÉTODO: Se trata de un estudio observacional, retrospectivo, de cohortes: una constituida por los pacientes intervenidos con cirugía endoscópica y otra por aquellos sometidos a cirugía láser (vaporización). En total 106 pacientes distribuidos en dos cohortes. A todos aquellos que cumplían los criterios de inclusión se les realizó dos cuestionarios, el International Prostate Sympton Score (IPSS), dos meses antes y seis meses después de la fecha de intervención y el Benign Prostate Hyperplasia Patient Impact Measure (HBP -PIM) seis meses después del acto quirúrgico. Se considera un nivel de significación estadística una p < 0.05% y un intervalo de confianza (IC) del 95 % RESULTADOS: La media del tamaño de próstata es de 55 centímetros cúbicos (cc) en los intervenidos con cirugía endoscópica frente a 40 cc en los operados mediante cirugía láser (p = 0,02). El 35,8% de los pacientes intervenidos con cirugía láser presentaron una clínica irritativa miccional frente al 6,2% de los intervenidos con cirugía endoscópica (p = 0,01). Dentro del grupo intervenido con láser, el 26,4% de los pacientes padecieron fuga de orina frente al 4,4% de los intervenidos mediante RTU bipolar (p = 0,03). El 86,7% de los pacientes de la cohorte de RTU bipolar dicen encontrarse muy felices tras la intervención frente al 53,6 % de la cohorte con cirugía láser (p = 0,03). CONCLUSIONES: En este estudio observacional retrospectivo los pacientes intervenidos mediante cirugía láser con láser LBO (LBO = triborato de litio) presentaron un empeoramiento de la calidad de vida en los seis meses posteriores de la intervención con respecto a los que fueron intervenidos mediante resección transuretral bipolar

OBJETIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy. METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p < 0.05% and a confidence interval (CI) of 95 %. RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8 % of patients treated with laser therapy had urinary irritative symptoms compared with 6.3 % in the endoscopic surgery group (p = 0.01). Within the laser group, 26.4 % of patients had urine leakage compared to 4.4 % among those operated by bipolar TUR (p = 0,03). 86.7 % of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6 % of the laser therapy cohort (p = 0.03). CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection

Un diagnóstico embriológico en la tercera edad / An Embryological Diagnosis in the Elderly

No disponible

Incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without associated risk factors.

PURPOSE: We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. RESULTS: Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. CONCLUSIONS: The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication.

Quality of life of patients with benign prostatic hyperplasia (BPH): endoscopic surgery versus laser therapy.

OBJECTIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy. METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p 〈 0.05% and a confidence interval (CI) of 95%. RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8% of patients treated with laser therapy had urinary irritative symptoms compared with 6.3% in the endoscopic surgery group (p = 0.01). Within the laser group, 26.4% of patients had urine leakage compared to 4.4% among those operated by bipolar TUR (p = 0,03). 86.7% of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6% of the laser therapy cohort (p = 0.03). CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection.

[Renal allograft rupture: case report and bibliographic review]. / Estallido renal. Caso clínico y revisión de literatura.

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Estallido renal. Caso clínico y revisión de literatura / Renal allograft rupture: case report and bibliographic review

OBJETIVO: Mejorar el conocimiento acerca de las complicaciones del transplante renal y en concreto la rotura del injerto. MÉTODO: Presentación de caso clínico y revisión de la literatura. RESULTADO: Presentamos un caso de una paciente de 37 años de edad sometida a su segundo injerto renal. En el tercer día del postoperatorio, sufrió un cambio brusco en la correcta evolución, con dolor intenso en fosa iliaca izquierda (donde se había instaurado el injerto) e inestabilidad hemodinámica. Las pruebas de imagen sugieren colección retroperitoneal y adyacente al injerto. En esta situación se decide reintervención donde se objetiva la ruptura de la unidad renal practicándose transplantectomía. El estudio anatomopatológico confirma que la causa de dicha ruptura viene establecida por un rechazo agudo del injerto. CONCLUSIONES: La ruptura del injerto es una de las complicaciones más graves en un transplante renal. Ante este acontecimiento se precisa un diagnóstico rápido y tratamiento quirúrgico. El manejo conservador es la medida a tomar para la posible preservación de la unidad renal, pero existen algunas situaciones en las que la conservación es peligrosa y se debe llevar a cabo la extirpación del injerto (AU)

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out (AU)

[Urodynamic findings in patients older than 65 years: experience in the Department 19 of the health-care area of Valencia (HCAV)]. / Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 de la Agencia Valenciana de Salud (AVS).

OBJECTIVES: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. METHODS: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population) (Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people). RESULTS: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 197%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibilily of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. CONCLUSIONS: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.

Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 del Área Valenciana de Salud (AVS) / Urodynamic findings in patients older than 65 years: experience in the Department 19 of the health-care area of Valencia (HCAV)

Objetivo: En este trabajo se pretende analizar los estudios urodinámicos realizados en mayores de 65 años en el Departamento 19 de la Agencia Valenciana de Salud (AVS) a fin de revisar nuestra actividad en ese segmento poblacional adscrito, durante el periodo de enero del 2001 y septiembre del 2006 y realizar una correlación clínico-urodinámica que ayude a alcanzar un diagnóstico evitando la necesidad de repetición de pruebas urodinámicas. Métodos: Para ello, se ha realizado un estudio descriptivo transversal con análisis retrospectivo de los pacientes mayores de 65 años a los que se ha realizado un estudio urodinámico. El total de la población comprendida en este rango de edad de nuestro Departamento Sanitario (D.S. número 19) es de 35260 habitantes (12% del total de la población). Agencia Valenciana de Salud. Dirección Asistencial Departamento Sanitario número 19. Hospital General Universitario de Alicante. Mayo 2005). Dentro de este grupo poblacional, el 41% son varones (14620 personas) y el 59% son mujeres (20637 personas). Resultados: En varones, el hallazgo exploratorio urodinámico más frecuente es el de obstrucción infravesical en casi la mitad de los casos (48%), siendo en segundo lugar la hiperactividad vesical con un 19% y la hiperactividad vesical idiopática a la par de la IUU con un 10% de nuestra población masculina. La no reproductibilidad de los síntomas alcanza el 9% de los casos. Por otro lado, no se confirma ningún caso de IUM, urgencia sensitiva ni micción no coordinada en los varones. Por otro lado, en la mujer lo más frecuente es la IUM con un 25% de los casos, seguido de la hiperactividad vesical con un 17%, la IUU con un 14% y la IUE con un 13% de la población femenina. La no reproductibilidad de los síntomas alcanza el 11%. En el otro extremo se encuentra la obstrucción infravesical y la disinergia detrusor/esfinteriana en los que no se presenta en ningún caso. Conclusión: Como conclusión encontramos que es la población entre 70 y 75 años el grupo poblacional al que se realizaron mayor número de exploraciones urodinámicas, en nuestro trabajo. El test urodinámico más frecuentemente practicado en nuestro Servicio fue el Estudio P/F con medición del residuo postmiccinal. El test de perfil uretral se reservó para la IUE recidivante tras cirugía previa. La sintomatología obstructiva en el varón y la IUM en la mujer fueron las causa que más condujeron a solicitar test urodinámicos. Nuestras tasas de no reproductibilidad de síntomas no superaron el 10% de los casos (AU)

Objectives: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. Methods: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population)(Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people) Results: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 19%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibility of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. Conclusions: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases (AU)

[Renal adenocarcinoma. Prognostic factors]. / Adenocarcinoma renal. Factores pronósticos.

OBJECTIVES: To perform a descriptive analysis of 57 cases of renal adenocarcinoma treated in our department, trying to identify those variables that modify survival, and to evaluate the impact of incidental diagnosis on survival. METHODS: 57 cases of renal cell carcinoma treated in our department from 1996 to 2001 were retrospectively reviewed. Mean follow-up time was 30 months. The impact on survival of incidental diagnosis, stage, and other variables was evaluated. We used the chi-square test to study the association between qualitative variables, and the prevalence proportion with 95% confidence intervals to quantify the magnitude of the association. RESULTS: Mean age on presentation was 63 +/- 12.57 yr. The most frequent histological type was classic renal cell carcinoma (83.6%). hematuria was the presenting sign in most cases. 19.3% were incidentally diagnosed with a 24 month survival was 100% in comparison to 59% of the patients presenting with clinical signs/symptoms (p = 0.0218); 24 month survival rates for stages I-II was 95.83% in comparison to 48.48% for stage III-IV. CONCLUSIONS: Renal cell adenocarcinoma is an aggressive tumor with a variety of clinical presentations which delay its diagnosis. Tumor stage is one of the main prognostic factors. Nowadays, the greater availability of radiological tests, mainly ultrasounds, has resulted on an increase in the number of incidental diagnosis and therefore a greater number of early stages; it is advisable to perform a renal pathology screening on every patient who undergoes abdominal ultrasound for any other reason.

Adenocarcinoma renal. Factores pronósticos / Renal adenocarcinoma. Prognostic factors

OBJETIVOS: Realizar el análisis descriptivo de los 57 casos de carcinoma de células renales tratados en nuestro servicio identificando aquellas variables que modifican la supervivencia y evaluar el impacto del diagnóstico incidental en la supervivencia. MÉTODOS: Se ha llevado a cabo el estudio retrospectivo de 57 casos de car. de céls. renales, tratados en nuestro servicio en el periodo de tiempo comprendido entre 1996-2001 con un tiempo de seguimiento medio de 30 meses. Se evaluó el impacto en la supervivencia del diagnóstico incidental y el estadio así como otras variables. Utilizamos el test de la chi-cuadrado para el estudio de la asociación entre variables cualitativas y la razón de prevalencia con intervalos de confianza al 95 por ciento para cuantificar la magnitud de la asociación. RESULTADOS: La edad media de presentación fue de 63+/- 12,57 años.El tipo histológico más frecuente fue el carcinoma de céls. renales clásico (83,6 por ciento).La presentación clínica mayoritaria fue la hematuria. El 19,3 por ciento fueron incidentales y la supervivencia a los 24 meses fue del 100 por ciento frente al 59 por ciento de los que presentaron clínica (p= 0,0218); la tasa de supervivencia a los 24 meses para los estadios I-II fue del 95,83 por ciento frente al 48,48 por ciento de los estadios III-IV.CONCLUSIONES: El adenocarcinoma de céls. renales es un tumor agresivo con gran variedad de manifestaciones clínicas que demoran su diagnóstico, siendo el estadio uno de sus principales factores pronósticos. Actualmente la mayor disponibilidad de técnicas radiológicas sobre todo las ultrasónicas, ha propiciado un incremento en el diagnóstico incidental y por lo tanto un mayor número de estadios precoces; es por todo ello que sería aconsejable realizar un despistaje de patología renal a todos los pacientes a los que se realizara una ecografía abdominal por cualquier motivo (AU)