ABSTRACT
La Incontinencia Urinaria (IU) había sido definida como un síntoma, pero actualmente constituye un problema importante de salud, puesto que afecta a la calidad de vida de las personas y su impacto socioeconómico es elevado.Su prevalencia es difícil de precisar porque las personas que la padecen no consultan específicamente por este problema, bien por desconocimiento (no creen que tenga solución), o porque aprenden a vivir con la IU.La IU no es un problema sin tratamiento. Depende de las causas, porque hay formas transitorias de incontinencia que se resuelven una vez tratada la causa que las ha originado. Existen también formas establecidas de incontinencia que precisan estudio y tienen tratamiento. Alguno de estos tratamientos pueden ser prescritos y seguidos por el médico de Atención Primaria.En otras ocasiones el paciente deberá ser derivado para estudio, una vez valoradas sus características individuales, como estado clínico, situación funcional, impacto y posibilidades reales de mejorar este problema (AU)
Subject(s)
Urinary Incontinence/epidemiology , Primary Health Care , Quality of Life , Socioeconomic FactorsABSTRACT
Transurethral resection (TUR) is the most frequent surgical treatment for symptomatic benign prostate hyperplasia (BPH). Prostate size is a significant factor for choosing TUR versus prostate adenomectomy. Analysis of flowmetry results obtained with TUR in 203 patients, based on weight of resected prostate tissue. Flowmetry was performed prior to TUR and prostate size was estimated with transabdominal ultrasound. Prostate tissue was weighed after TUR and a new flowmetry was performed 6 months after treatment. Mean weight of resected tissue was 31.34 g. When all flowmetry parameters analyzed pre-and post TURs were compare, there were significant differences (p < 0.001). Increased maximum flow (Qmax) and increased mean flow (Qmed) occurred in 91.7% and 96.31% patients, respectively. Mean increase of post-surgical Qmax was significantly higher (p > 0.01) in patients with Qmax prior to surgery lower than 8 ml/s. No significant correlation was demonstrated between prostate volume measured by ultrasound or resected prostate tissue and increased post-surgical Qmax. TUR improves flowmetry parameters, mainly in patients with pre-surgical Qmax lower than 8 mL/s. Extensive prostate resection does not appear to improve the flowmetry results obtained with a sufficient functional TUR.
Subject(s)
Prostatectomy , Urination , Aged , Humans , Male , Rheology , UrineABSTRACT
OBJECTIVE: To analyze the clinical complications of double-J ureteral catheters. METHODS: The most relevant studies published in the literature since the self-retaining indwelling catheter was first described in 1967 are reviewed. RESULTS: The experience and results reported in the most relevant studies are presented. CONCLUSIONS: The double-J ureteral stent has become an integral part of the urological armamentarium. It allows good urinary drainage from the kidney to the bladder and is generally safe and well-tolerated. However, different complications may occur with short- or long-term use of indwelling stents. These complications vary from minor side effects such as hematuria, dysuria, frequency, flank and suprapubic pain, to major complications such as vesico-ureteric reflux, stent migration, encrustation, urinary infection, stent fracture, necrosis and ureteral fistula. Most of these complications require removal of the catheter.
Subject(s)
Urinary Catheterization/adverse effects , Urinary Catheterization/instrumentation , Equipment Failure , Foreign-Body Migration/etiology , Humans , Urinary Tract Infections/etiology , Vesico-Ureteral Reflux/etiologyABSTRACT
Stones with different compositions respond differently to shock wave lithofragmentation. Likewise, the various lithotrity systems used may have different effects on the stones. To determine the relationships between stone composition and their fragmentation patterns, we conducted an in vitro study using endoscopy, magnifying glass, light microscope and scanning electron microscope on fragments obtained after lithotrity of 60 pure stone with different compositions: calcium oxalate monohydrate and dihydrate (OXMH and OXDH), phosphocarbonate (PC), ammonium magnesium phosphate (AMF) and uric acid (UA). Fragmentation was carried out with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulse laser). No morphologic differences in the fractures induced by the various lithofragmenting sources were demonstrated. OXMH and UA stones basically break up by intercrystalline fracture and splitting of their concentric plates. OXDH breaks up mainly by intercrystalline fractures aided by the fibrillar organic material and phosphocarbonates found in the intercrystalline spaces. Fragmentation in infective stones (AMF and PC) occurs across the intercrystalline surfaces and by intracrystalline fracture. Ammonium urate fragments break up by intracrystalline fractures that run across the equatorial plane of its characteristic acicular microspheres.
Subject(s)
Lithotripsy , Urinary Calculi/ultrastructure , Crystallization , Endoscopy , Humans , Microscopy, Electron, ScanningABSTRACT
Case report of a patient bearer of a double-J ureteral catheter due to ureteral lithiasis. After persistent renoureteral pain and fever, the proximal migration of the catheter is confirmed radiologically. The predisposing factors for this complication, described in the literature, are reviewed.
Subject(s)
Foreign-Body Migration/etiology , Urinary Catheterization/adverse effects , Adult , Disease Susceptibility , Foreign-Body Migration/diagnosis , Foreign-Body Migration/therapy , Humans , Male , Ureter , Ureteral Calculi/complications , Ureteral Calculi/therapy , Ureteroscopy , Urinary Catheterization/instrumentationABSTRACT
OBJECTIVE: To determine whether knowledge about the degree of radiopacity of the double-J ureteral catheters utilized in Spanish hospitals suffices for correct radiologic control and subsequent follow-up. METHODS: The CT attenuation index was utilized to determine the degree of radiopacity of 23 double-J ureteral stents, comprised of different biomaterials and from different manufacturers, that are used in Spanish hospitals. RESULTS: The values ranged from 1,000-3,070 Hounsfield units. CONCLUSION: All the catheters analyzed were sufficiently radiopaque to permit good radiologic control during insertion and subsequent follow-up. The radiopacity of the stent depends on the metal salt employed during the manufacturing process and not on the biomaterial.
Subject(s)
Materials Testing , Tomography, X-Ray Computed , Urinary Catheterization/instrumentationABSTRACT
The results of shockwave lithofragmentation are conditioned by stone composition. Similarly, the different types of lithofragmenting energy can have different effects on the calculi. The purpose of this experimental study is to establish a relationship between calculi composition and type of energy used for fragmentation, with the results of the lithotriptsy treatment. 60 calculi, 12 for each pure composition selected (calcium oxalate mono and dihydrate, phosphocarbonate, ammonium magnesium phosphate and uric acid) underwent in vitro lithofragmentation with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulsed laser). It was carried out a study of fragmentation in particles under 3 mm and pulverization in particles under 0.5 mm, analyzing post-lithotriptsy fragments with scanning electron microscopy associated to X-ray dispersion energy. No relationship was shown between calculi composition and amount of energy supplied for the fragmentation. The lithiasic composition correlates to the fragmentation pattern, so that oxalocalcium calculi undergoes good fragmentation and poor pulverization, infective calculi have poor fragmentation but good pulverization and uric acid calculi show poor fragmentation and pulverization.
Subject(s)
Lithotripsy/methods , Urinary Calculi/therapy , Humans , In Vitro Techniques , Urinary Calculi/chemistryABSTRACT
Pre-treatment knowledge of the lithiasic composition can be useful to design the most appropriate therapeutic scheme for each kind of stone. The relationship between the stone's densitometry information provided by the different imaging techniques, conventional radiology (RX), computerized axial tomography (CAT) and dual energy radiographic densitometry (DO) is analyzed, as well as the elemental composition determined by the microanalysis of fragments obtained post-lithotrity using a scanning electronic microscope (SEM) associated to X-ray dispersion energy (XDE). 60 stones, 12 for each pure composition selected (calcium oxalate mono and dihydro, phosphocarbonate, magnesium ammonium phosphate and uric acid), were studied with XR, CAT and DO and were later subjected to lithofragmentation in vitro. Fragments analysis was carried out post-lithotrity with SEM associated to XDE. The X-ray does not allow to establish the composition of some calculi. CAT quantifies the mineral contents of the oxalocalcic and infective calculi and differentiates the uric acid from the other compositions because the mean density values are under 500 Hounsfield Units. DO evaluates the lithiasic content in phosphocarbonate salts which are structurally similar to bone hydroxyapatite.
Subject(s)
Urinary Calculi/chemistry , Absorptiometry, Photon , Humans , Microscopy, Electron, Scanning , Radiography , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To analyze the clinical indications of double-J ureteral catheters. METHODS: The most relevant studies published in the literature since the self-retained indwelling catheter was first described in 1967 are reviewed. RESULTS: The experience and results reported in the most relevant studies are presented. CONCLUSIONS: The double J ureteral catheter is essential in urological practice. Although its clinical indications are well-established, its use depends on the urologist's experience in most of the cases.
Subject(s)
Catheters, Indwelling , Ureteral Diseases/therapy , Ureteral Obstruction/therapy , Urinary Catheterization/instrumentation , Urinary Fistula/therapy , Humans , Kidney Transplantation/adverse effects , Ureteral Calculi/complications , Ureteral Calculi/therapy , Ureteral Obstruction/surgeryABSTRACT
Current treatment for disseminated prostate cancer, whether progressive or hormone-resistant, do not improve survival. Insulin growth factors (IGFs) are potent stimulants of prostate epithelial cells growth, their presence having been demonstrated in high quantities in several tumours such as lung, hepatoma, pheochromocytoma, malignant glioma and breast cancer. Local management of growth factors production could improve the results of second line therapy in hormone-resistant prostate cancer. Levels of IGF-I were determined by radioimmunoassay (RIA) in normal (n = 5), hyperplastic (n = 5) and tumoral (n = 8) prostate tissue. Presence of IGF-I is confirmed in all tissues (9.62 +/- 5.81; 8.32 +/- 7.81 and 6.02 +/- 1.42 ng/mg protein, respectively) but no significant differences are displayed among the three groups.
Subject(s)
Insulin-Like Growth Factor I/analysis , Insulin-Like Growth Factor I/biosynthesis , Prostate/chemistry , Prostatic Hyperplasia/metabolism , Prostatic Neoplasms/chemistry , Adult , Aged , Aged, 80 and over , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: To analyze the shock wave effects on double-J stent. METHODS: Retention strength modifications induced by shock waves were analyzed: a) 60 double-J stents obtained from patients were compared (20 had not been treated by ESWL; 20 had been treated by piezoelectric-ESWL and 20 by electrohydraulic-ESWL; b) the effects of piezoelectric-ESWL were determined in vitro using 36 stress-tested double-J stent segments (Urosoft, C-Flex and silicone) vs. a control group. RESULTS: The retention strength of the stents from ESWL-treated patients, especially those that had been submitted to piezoelectric-ESWL, was lower than in stents from patients that had not undergone ESWL (p < 0.05). The foregoing has been corroborated by the in vitro findings. The impact frequency causing maximum damage is specific for each material. Microphotographic studies revealed fracture lines on the surfaces of the ESWL-treated stents (Urosoft and C-Flex). CONCLUSIONS: The foregoing findings may explain the high incidence of double-J stent migration observed in ESWL-treated patients.
Subject(s)
Catheterization , Lithotripsy , Urinary Catheterization/instrumentationABSTRACT
The present study reviewed the first 25 incontinence prostheses implanted at the Urology Services of the Ramón y Cajal Hospital. The literature is briefly reviewed and the indications for the AUS-800 incontinence prosthesis are discussed.
Subject(s)
Urinary Incontinence/surgery , Urinary Sphincter, Artificial , Adolescent , Adult , Aged , Child , Equipment Design , Female , Humans , Male , Middle Aged , Reoperation , Treatment OutcomeABSTRACT
Management of surface vesical tumours using laser photocoagulation has proven to be a safe and effective method. The technique can be performed under anaesthetic sedation and in the outpatient clinic environment thus allowing a considerable cost saving and the reduction of hospital's waiting lists. Throughout 1990, 47 patients with relapsing vesical tumours were treated in 55 sessions. Most cases were performed on ambulatory patients with a low complications rate and an estimated saving of 18,326,400 pesetas as compared to transurethral resection.
Subject(s)
Laser Coagulation , Urinary Bladder Neoplasms/surgery , Adult , Ambulatory Surgical Procedures , Cost-Benefit Analysis , Female , Humans , Laser Coagulation/economics , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , SpainABSTRACT
Augmentation and substitution erocystoplastias are currently widely accepted techniques for the treatment of several benign and malignant diseases. Appearance of neoplasia on the various gut segments used after a latency period ranging from 5 to 25 years following initial surgery has been described. The paper presents one case of metastatic colon adenocarcinoma initially located in the region of ureteral reimplantation, in a patient with augmentation cecocystoplastia performed as a result of vesical retraction secondary to genitourinary tuberculosis. Appearance of this type of neoplasia in an increasing population, quite often young, compels the urologist to keep a tight watch. Endoscopic monitoring of the new bladder is the most effective diagnostic procedure. A once-a-year endoscopy after an interval as yet not definitely established, but which could be around 10 years after initial enterocystoplastia, seems advisable at least in cases at higher risk.
Subject(s)
Adenocarcinoma/pathology , Colonic Neoplasms/pathology , Tuberculosis, Urogenital/surgery , Adenocarcinoma/etiology , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/secondary , Aged , Autopsy , Cecum/surgery , Colonic Neoplasms/etiology , Humans , Lung Neoplasms/pathology , Lung Neoplasms/secondary , Male , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Thyroid Neoplasms/pathology , Thyroid Neoplasms/secondary , Tuberculosis, Renal/complications , Tuberculosis, Renal/surgery , Tuberculosis, Urogenital/complications , Urinary Bladder/surgery , UrographyABSTRACT
The chemical composition of 29 of the bottled mineral waters available in the Spanish market are analyzed, including composition of the tap water supplied by Canal de Isabel II, which provides drinkable water to Madrid with a population close to 5 million inhabitants. The literature relevant to the influence water and its composition may have on the lithiatic prophylaxis is reviewed, exploring data related to our waters, and offering an approach on their use in the different types of lithiasis.
Subject(s)
Mineral Waters/analysis , Water Supply/analysis , Humans , Urinary CalculiABSTRACT
We report on an 88-year-old male patient with a bladder stone that had been incidentally detected and found to contain a foreign body, which was shown to be a urethral dilator on microscopic and chemical analyses. The calculi had three well-defined layers with clearly infective features. The literature on bladder stone formation is reviewed and the clinical features and treatment are discussed.
Subject(s)
Dilatation/instrumentation , Foreign Bodies/complications , Urinary Bladder Calculi/etiology , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/complications , Dilatation/adverse effects , Escherichia coli Infections/complications , Humans , Iatrogenic Disease , Male , Urinary Tract Infections/complicationsABSTRACT
We present a case of colovesical fistula secondary to vesical gangrene. Precipitating factors were diabetes and vesical distension caused by the obstruction of an indwelling catheter. This complication is an exceptional outcome in gangrenous cystitis and it requires emergency surgical treatment.
Subject(s)
Colonic Diseases/etiology , Cystitis/complications , Diabetes Mellitus, Type 2/complications , Intestinal Fistula/etiology , Urinary Bladder Fistula/etiology , Aged , Aged, 80 and over , Colonic Diseases/diagnosis , Cystitis/diagnosis , Gangrene , Humans , Intestinal Fistula/diagnosis , Male , Urinary Bladder Fistula/diagnosisABSTRACT
Reporting the case of a patient diagnosed with an abscess of the seminal vesicle, treated successfully through parasacral transgluteal percutaneous aspiration lead by computerized axial tomography (CAT). This represents the first case in the literature of percutaneous access to the seminal vesicles through this route. CAT is an effective diagnostic test which makes non-surgical treatment for this type of abscess simpler. A review is made of the literature with regard to the etiology, diagnosis and therapy of seminal vesicle abscesses.
Subject(s)
Abscess , Escherichia coli Infections , Seminal Vesicles , Abscess/diagnostic imaging , Abscess/drug therapy , Abscess/etiology , Abscess/surgery , Ampicillin/therapeutic use , Combined Modality Therapy , Drainage/methods , Drug Therapy, Combination/therapeutic use , Escherichia coli Infections/diagnostic imaging , Escherichia coli Infections/drug therapy , Escherichia coli Infections/etiology , Escherichia coli Infections/surgery , Genital Diseases, Male/complications , Genital Diseases, Male/drug therapy , Genital Diseases, Male/microbiology , Humans , Male , Middle Aged , Seminal Vesicles/diagnostic imaging , Seminal Vesicles/microbiology , Seminal Vesicles/surgery , Tobramycin/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Urodynamic pressure-flow studies (Whitaker test) of 28 kidneys (21 orthotopic and 7 transplanted) with equivocal obstruction of the upper urinary tract (UUT) yielded a sensitivity rate of 77.7% and a specificity rate of 75% in the orthotopic kidney, and sensitivity and specificity rates of 75% in the transplanted kidney. Trauma to the transplanted kidney (denervation, ischemia and surgery) does not modify the urodynamic of the pyelocaliceal system, thus conferring on the test the same diagnostic reliability as in the orthotopic kidney.
