Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access.

INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal / Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)

[Tolerance of prostate biopsy with use of local anesthesia and benzodiazepines: a randomized, prospective study]. / Tolerancia a la biopsia prostática con el uso de anestesia local y benzodiacepinas: estudio prospectivo aleatorizado.

INTRODUCTION: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. MATERIALS AND METHODS: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. RESULTS: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant differences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant differences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant difference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant differences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). CONCLUSION: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted.

Tolerancia a la biopsia prostática con el uso de anestesia local y benzodiacepinas: estudio prospectivo aleatorizado / Tolerance of prostate biopsy with use of local anesthesia and benzodiazepines: a randomized, prospective study

Introducción: la biopsia prostática es un procedimiento molesto, lo que condiciona que constantemente intentemos disminuir el dolor durante su realización. Material y métodos: diseñamos un estudio prospectivo aleatorizado en el que incluimos 160 procedimientos. Criterios de inclusión: primera biopsia, antígeno prostático específico (PSA) < 15 ng/ml, edad menor de 75 años. Los pacientes fueron aleatorizados en 4 grupos. El primero (A) quedó como control, el B recibió anestesia intracapsular (8 ml de lidocaína 2%), el C 5 mg de clorazepato dipotásico vía oral una hora antes y en el D se aplicaron las dos medidas (anestesia local y clorazepato). Se entregó un cuestionario con tres medidas de dolor (valorándolo de 0 a 10) tras el procedimento y otro 30 minutos después. Resultados: las medias del dolor fueron 5,17 (A), 1,72 (B), 2,43 (C) y 0,88 (D) en el primer cuestionario. En el segundo fueron 1,71, 0,25, 0,75 y 0,35, respectivamente. La comparación de medias realizada mediante el test de ANOVA pone de manifiesto diferencias significativas. Al comparar los grupos entre sí encontramos: 1. A frente a B: diferencia significativa en ambos cuestionarios (p 0,006 y 0,011). 2. A frente a C: no significación en el primer cuestionario (0,051) y sí en el segundo (0,012). 3. A frente a D: diferencia en ambos cuestionarios (0,001 y 0,010). El uso de benzodiacepinas añadidas a la anestesia local (B frente a D) no mostró diferencias estadísticas en ambos cuestionarios (0,825 y 0,685). Conclusión: consideramos que el uso de benzodiacepinas no está justificado como método único de control del dolor para la realización de la biopsia prostática(AU)

Introduction: Prostate biopsy is an uncomfortable procedure, and attempts are therefore being constantly made to try and decrease biopsy-related pain. Materials and methods: A randomized, prospective study including 160 procedures was designed. Inclusion criteria were: first biopsy, PSA < 15 ng/mL, and age under 75 years. Patients were randomized into 4 groups. Group A was the control group, while group B received intracapsular anesthesia (8 mL of 2% lidocaine), group C 5 mg of oral clorazepate dipotassium one hour before biopsy, and group D both local anesthesia and clorazepate. Each patient completed a questionnaire including three 10-point visual analog scales for pain immediately after the procedure and 30 minutes later. Results: Mean pain scores were 5.17 (group A), 1.72 (group B), 2.43 (group C), and 0.88 (group D) in the first questionnaire, and 1.71, 0.25, 0.75 and 0.35 respectively in the second questionnaire. Statistically significant di fferences were found in the ANOVA test. Group comparisons showed the following: 1. A vs B: statistically significant di fferences in both questionnaires (p = 0.006 and 0.011). 2. A vs C: a significant di fference was found in the first questionnaire (0.051), but not in the second (0.012). 3. A vs D: significant di fferences in both questionnaires (0.001 and 0.010). No statistically significant differences were seen in both questionnaires (0.825 and 0.685) when benzodiazepines where added to local anesthesia (B vs D). Conclusion: Use of benzodiazepines as a single method to decrease biopsy-related pain is not warranted(AU)

[Rhabdomyolysis after laparoscopic nephrectomy: case report]. / Rabdomiolisis tras nefrectomía laparoscópica; a propósito de un caso.

OBJECTIVE: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. METHODS: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. RESULTS: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60 degrees flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. CONCLUSIONS: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery.

Litiasis ureteral en paciente portadora de derivación urinaria tipo Bricker / Ureteral lithiasis in a patient with Bricker type urine diversion

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Rabdomiolisis tras nefrectomía laparoscópica; a propósito de un caso / Rhabdomyolysis after laparoscopic nephrectomy: case report

Objetivos: Nos planteamos en este caso clínico mostrar el manejo de la rabdomiolisis secundaria a la cirugía laparoscópica y como el tratamiento médico puede ser suficiente para una correcta resolución del mismo. Métodos: La nefrectomía laparoscópica es una técnica de rutina, no exenta de morbilidad asociada. Presentamos un caso de rabdomiolisis que debutó como dolor glúteo e impotencia funcional, junto con alteraciones cutáneas, insuficiencia renal aguda y enzimas musculares elevadas. Resultados: En nuestro caso el paciente evolucionó satisfactoriamente con tratamiento médico. Hacemos una revisión de la literatura publicada, donde se identifican múltiples factores de riesgo, tales como el IMC (índice de masa corporal), tiempo quirúrgico, la posición durante el acto quirúrgico en decúbito lateral con flexión 40-60°. La prevención es el factor más importante para evitar la insuficiencia renal aguda por mioglobina. Conclusiones: La prevención, la detección precoz y la instauración inmediata de medidas terapeúticas son fundamentales para la buena resolución del cuadro de rabdomiolisis tras cirugía (AU)

Objective: To show the clinical management of rhabdomyolysis secondary to laparoscopic surgery and how clinical treatment may be enough for adequate resolution. Methods: Laparoscopic nephrectomy is a routine technique, which may have associated morbidity. We present one case of rhabdomyolysis which presented as gluteal pain and functional impotency, together with skin lesions, acute renal failure and elevated muscle enzymes. Results: In our case, the patient had a satisfactory outcome with medical treatment. We perform a bibliographic review in which we identify multiple risk factors, such as body mass index, surgical time, position during operation with lateral decubitus and 40-60° flexion. Prevention is the most important factor to avoid acute renal failure secondary to myoglobin. Conclusions: Prevention, early detection, and immediate start of therapeutic measures are essential for the good resolution of rhabdomyolysis after surgery (AU)

[Use of urography by magnetic resonance for the study of the urinary apparatus versus conventional urography]. / Uso de la urografia por resonancia magnética en el estudio del aparato urinario frente a la urografía convencional.

UNLABELLED: Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. OBJECTIVE: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU. MATERIALS AND METHODS: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. RESULTS: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%. CONCLUSION: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.

Uso de la urografía por resonancia magnética en el estudio del aparato urinario frente a la urografía convencional / Use of urography by magnetic resonance for the study of the urinary apparatus versus conventional urography

La urografía convencional (UIV) es una exploración fundamental en la valoración del aparato urinario no exenta de morbilidad, como reacciones adversas al contraste (vasovagales y anafilácticas), neurotoxicidad, nefrotoxicidad, así como la irradiación ionizante a la que somete al paciente. Por este motivo se desarrollan técnicas de imagen alternativas como la urografía por resonancia magnética (RM) o urorresonancia. Objetivos: Presentamos un estudio que valora la precisión diagnóstica, especificidad y sensibilidad de la urorresonancia y de la UIV como exploración morfológica y funcional del aparato urinario; así como de la calidad de las imágenes urográficas obtenidas con la RM frente a la UIV. Material y métodos: 150 pacientes han sido sometidos a un estudio de RM, en 63 de ellos se realizó también estudio urográfico convencional, con apreciación de señales de alta intensidad en T2 correspondientes al fluido abdominal y retroperitoneal, empleando previamente furosemida a bajas dosis, y en un estudio final, administrando gadolinio a razón de 0,1 mg./Kg. La prueba fue indicada en pacientes con antecedentes de reacciones adversas al contraste yodado, fracaso renal agudo o crónico, anulación funcional renal, pacientes embarazadas y en edad infantil así como cuando la UIV no fue diagnóstica. Se estudió la capacidad de ambas pruebas para el diagnóstico de obstrucción urinaria y de la etiología de esta. También se evalúo la calidad de las imágenes que ofrece el estudio urográfico con RM. Resultados: Se obtuvieron imágenes de alta resolución con la RM de toda la vía urinaria superior, especialmente de pelvis renal, no artefactadas por la peristalsis o la interposición del fluido intestinal. En el 83,3% de los casos la exploración reveló patología urológica. La precisión diagnóstica de la causa de afectación del aparato urinario fue de un 83,3%, con una sensibilidad del 89,6%, una especificidad del 69,2%, valor predictivo positivo del 86,6% y valor predictivo negativo del 75%. Conclusión: La urografía por RM es una técnica con una elevada sensibilidad para el estudio del aparato urinario, que puede ser empleada como alternativa a la urografía convencional especialmente en los casos de contraindicación de la radiación ionizante, alergia al contraste, así como en pacientes con fracaso renal, pero que ofrece un estudio morfológico y funcional más amplio, con elevada calidad de imágenes, pudiendo desplazar a los estudios convencionales en un plazo corto o medio de tiempo

Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. Objective: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract; and a quality study of the urographic images obtained with MR versus IVU. Materials and methods: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. Results: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%, a positive predictive value of 86.6% and a negative predictive value of 75%. Conclusion: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term

Complicaciones de la prostatectomía radical: evolución y manejo conservador de la incontinencia urinaria / Radical prostatectomy complications: evolution and conservative management of urinary incontinence

Objetivos: La prostatectomía radical retropúbica continúa siendo el tratamiento de elección para el cáncer de próstata órganoconfinado. Realizamos un estudio retrospectivo en el que valoramos las complicaciones de esta cirugía y su evolución en el tiempo así como la cantidad del tratamiento conservador, especialmente la rehabilitación perineal precoz, en la recuperación de la continencia tras esta intervención. Material y métodos: Durante el período comprendido entre diciembre de 1998 a enero del 2005 hemos intervenido en nuestro servicio a 168 pacientes afectos de adenocarcinoma prostático confinado clínicamente a la glándula mediante prostatectomía radical retropúbica. Retiramos la sonda vesical el decimocuarto día del postoperatorio. A los pacientes que presentarion incontinencia urinaria (IU) de esfuerzo se les instruyó para la realización de ejercicios para fortalicer el suelo pélvico. Realizamos un seguimiento clínico el primer, tercer y sexto mes tras la cirugía, y posteriormente de forma semestral. Resultados: De los 168 pacientes intervenidos, el 15% requirió hemotransfusión en el postoperatorio inmediato. Otras complicaciones precoces, de mucha menos incidencia, fueron la perforación intestinal, la infección de la herida quirurgica y la foramción de hematoma en el lecho quirúrgico. Entre las complicaciones tardías más frecuentes registramos la disfunción eréctil, que se presentó en 164 pacientes (98%), alteraciones miccionales en 32 pacientes (19%) y alteraciones intestinales en aproximadamente el 11%. Entre las alteraciones miccionales encontradas, la más frecuente fue la IU (64%) si bien la mayoría de ellas eran de carácter leve (34%) y todas mejoraron durante los primeros seis meses posteriores a la cirugía. Conclusiones: La IU es el principal condicionante de la calidad de vida de los pacientes que son sometidos a prostatectomía radical. Si bien el porcentaje de pacientes que la presenta es alto, la mayoría son de grado leve o moderado y pueden mejorar ostensiblemente con los ejercicios de fortalecimiento del suelo pélvico, constituyéndose así como un arma fundamental en el menejo de estos pacientes, acompañada o no del uso de absorbentes, de la terapia farmacológica o del empleo de colectores peneanos

Objectives: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complication of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary incontinence. Materials and methods: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and there after every six monoths. Results. Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion inthe immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. Conclusions. Radical prostatectomy continues to the most effective treatment for the non spared prostate cancer, in spite, of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors

[Radical prostatectomy complications: evolution and conservative management of urinary incontinence]. / Complicaciones de la prostatectomia radical: evolución y manejo conservador de la incontinencia urinaria.

OBJECTIVES: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence. MATERIALS AND METHODS: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months. RESULTS: Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. CONCLUSIONS: Radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors.

[Experimental study of the immunomodulator effect of pentoxifylline in bacterial translocation produced by lipid-free parenteral nutrition]. / Estudio experimental sobe la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos.

INTRODUCTION: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-alpha, which seems to be linked to the progress of these conditions towards multiple organ failures. MATERIAL AND METHOD: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-alpha. The data obtained were subsequently analyzed statistically. RESULTS: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-alpha, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. CONCLUSIONS: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-alpha.

Estudio experimental sobre la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos / Experimental study on the immune modulation influence of pentoxiphylline on bacterial translocation produced by lipid-free parenteral nutrition

Introducción: La translocación bacteriana (TB) provoca sepsis de origen intestinal y a pesar de los avances actuales existe una elevada morbimortalidad por sepsis por esta causa. Hemos querido investigar si una sustancia inmunomoduladora como es la pentoxifilina (PX), podía disminuir o inhibir la TB. Hemos elegido la PX por tener acciones inmunomoduladoras y por inhibir la síntesis y la actuación del TNF-alfa, que parece tener relación con el avance hasta el fallo multiorgánico en estos cuadros. Material y método: Se realiza un estudio experimental con 4 grupos de 20 ratas Wistar a las que se les ha sometido a una nutrición parenteral sin lípidos (NP) durante 7 días. Al grupo A: NP; grupo B: NP + 50mg/kg de PX; grupo C: NP + 100mg/kg y grupo D: NP + 134m/kg. Al 7º día se extrae de forma estéril la cadena ganglionar mesentérica, hígado, sangre e intestino, estas muestras se procesan para realizar el estudio microbiológico cuantitativo y cualitativo, estudio histológico de la mucosa intestinal y cuantificación del TNF-alfa. A los datos obtenidos se les aplica un estudio estadístico. Resultados: En el estudio microbiológico cuantitativo se observó que el en el ganglio linfático, hígado y sangre crecieron más colonias en los animales que pertenecían al grupo A con diferencias estadísticamente significativas. El germen que con más frecuencia se identificó fue E. coli. En el estudio del TNF-alfa, el mayor valor medio lo obtuvo el grupo A, con diferencias estadísticamente significativas. En el estudio histológico se observó que el grupo con más atrofia era el grupo A. Conclusiones: Nuestro modelo experimental es válido como modelo de TB, en el grupo A sin PX se produjeron 16 TB y en los grupos con PX se disminuye el número de TB y las cifras de TNF-alfa en suero (AU)

Introduction: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-α, which seems to be linked to the progress of these conditions towards multiple organ failures. Material and method: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-α. The data obtained were subsequently analyzed statistically. Results: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-α, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. Conclusions: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-α (AU)

Gangrena de Fournier en Urgencias / Fournier´s gangrene in Emergency-Department

La gangrena de Fournier es una infección genital grave cuyo pronóstico vital depende en gran medida de un diagnóstico precoz que, como en muchas otras situaciones, va a recaer sobre el médico de urgencias ya que el paciente consultará de forma urgente por la rápida progresión de la infección. Se presenta el caso de un paciente que acude a urgencias del hospital donde se le diagnostica una gangrena de Fournier con afectación peneana y escrotal. Se discute la necesidad de un diagnóstico adecuado y sobre todo temprano, ya que esto aumentará las posibilidades de supervivencia de los pacientes (AU)

[The impact of creating andrology units on the treatment of erectile dysfunction with intracavernosal injections]. / Impacto de la creación de las unidades de andrología en el tratamiento por inyecciones intracavernosas de la disfunción eréctil.

OBJECTIVE: The impact of the creation of the andrology unit on intracavernous injection therapy for erectile dysfunction is analyzed in the present study. METHODS: The records of patients treated by intracavernosal injection of vasoactive drugs for erectile dysfunction from 1990 to 1997 were reviewed. RESULTS/CONCLUSIONS: Demands for solutions to the problem of erectile dysfunction have significantly increased over the last decades. The efficacy of intracavernosal injection of vasoactive drugs in the treatment of erectile dysfunction has been demonstrated. After the creation of the andrology unit within the urology services, patient acceptance of treatment and compliance increased, and complications have diminished.