La prostatectomía radical retropúbica abierta es todavía una técnica quirúrgica bien establecida para el tratamiento del cáncer de próstata / Open retropubic radical prostatectomy: Still a well-established surgical technique for prostate cancer management

Introducción Las opciones de tratamiento quirúrgico del cáncer de próstata han experimentado cambios significativos gracias a la expansión de la robótica. Sin embargo, la prostatectomía radical retropúbica abierta (PRA) seguirá realizándose en aquellos entornos con limitaciones económicas o con escaso acceso a la robótica. El objetivo de este estudio fue determinar los resultados oncológicos a largo plazo, clasificar las tasas de complicaciones y examinar las tasas de recuperación temprana de la continencia en pacientes tratados con PRA. Métodos Identificamos a todos los pacientes sometidos a PRA en nuestra institución entre 2000 y 2020. Se utilizó un pad test (prueba de la compresa) estandarizado para determinar las tasas de continencia precoz tras la retirada del catéter; la continencia tardía, alrededor de un año después de la cirugía, se determinó mediante el número de compresas por día. Se utilizó la clasificación de Clavien-Dindo para informar las tasas de complicaciones. Las tasas de supervivencia libre de recidiva bioquímica (RB) y de supervivencia global (SG) se definieron mediante el método de Kaplan-Meier y el análisis log-rank. Se utilizaron modelos multivariantes de regresión de Cox para comprobar el efecto de los distintos factores sobre la recidiva bioquímica. Resultados Se analizaron los datos de 1.095 pacientes. La mediana de seguimiento fue de 93,4 meses. Se encontró una supervivencia global libre de RB a 10años y una SG del 73% y del 82%, respectivamente. Se observó una tasa de complicaciones de Clavien Dindo ≥3 en el 4,8% de los pacientes. La tasa de continencia precoz fue del 81,4% y la tasa de continencia tardía fue del 89,1%. El nivel de PSA preoperatorio, la suma de la puntuación de Gleason, el estadio pT, el estado de los ganglios linfáticos y el estado de los márgenes quirúrgicos fueron predictores independientes de RB (p<0,001). Entre las limitaciones del estudio están su diseño retrospectivo y unicéntrico (AU)

Introduction The surgical treatment options for prostate cancer have changed rapidly, given the expansion of robotics. However, open retropubic radical prostatectomy (ORP) will continue to be performed in areas with financial limitations or with limited access to robotics. The purpose of this study was to determine the long-term oncological outcomes, to categorize complication rates and to examine the early continence rates in patients treated with ORP. Methods We identified all patients who underwent ORP at our institution between 2000 and 2020. A standardized pad test was used to determine the early continence rates upon catheter removal, the late continence around a year after surgery was determined by the number of pads per day. The Clavien-Dindo classification was used to report the complication rates. The biochemical recurrence (BCR)-free survival and overall survival (OS) rates were defined using the Kaplan-Meier method and log-rank analysis. Multivariable Cox-regression models were used to test the effect of different factors on biochemical recurrence. Results We analyzed 1095 patients. The median follow-up was 93.4months. An overall 10-year BCR-free survival and OS of 73% and 82% respectively was found. A complication rate for Clavien Dindo ≥3 was seen in 4.8% of patients. The early continence rate was 81.4% and the late continence 89.1%. Preoperative PSA level, Gleason score sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (P<.001). Limitations include retrospective and single centre study design. Conclusions ORP is a surgical procedure that provides excellent oncological- and early continence-rates (AU)

Open retropubic radical prostatectomy: Still a well-established surgical technique for prostate cancer management.

INTRODUCTION: The surgical treatment options for prostate cancer have changed rapidly, given the expansion of robotics. However, open retropubic radical prostatectomy (ORP) will continue to be performed in areas with financial limitations or with limited access to robotics. The purpose of this study was to determine the long-term oncological outcomes, to categorize complication rates and to examine the early continence rates in patients treated with ORP. METHODS: We identified all patients who underwent ORP at our institution between 2000 and 2020. A standardized pad test was used to determine the early continence rates upon catheter removal, the late continence around a year after surgery was determined by the number of pads per day. The Clavien-Dindo classification was used to report the complication rates. The biochemical recurrence (BCR)-free survival and overall survival (OS) rates were defined using the Kaplan-Meier method and log-rank analysis. Multivariable Cox-regression models were used to test the effect of different factors on biochemical recurrence. RESULTS: We analyzed 1095 patients. The median follow-up was 93.4 months. An overall 10-year BCR-free survival and OS of 73% and 82% respectively was found. A complication rate for Clavien Dindo≥3 was seen in 4.8% of patients. The early continence rate was 81.4% and the late continence 89,1%. Preoperative PSA level, Gleason score sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (p<0.001, 95% CI). Limitations include retrospective and single center study design. CONCLUSIONS: ORP is a surgical procedure that provides excellent oncological- and early continence-rates.

Técnica de reconstrucción de ligamentos pélvicos según la Teoría Integral / Pelvic Ligament Reconstruction Technique According to Integral Theory

La patología de piso pélvico es una entidad multifactorial con un conjunto de síntomas ginecológicos, urinarios, fecales y de sensibilidad pelviperineal. La Teoría Integral de la Continencia propone un tratamiento holístico con la reconstrucción de los ligamentos del piso pélvico. La presente técnica propuesta constituye una alternativa quirúrgica que permite dar respuesta de forma global a los síntomas que refieren las pacientes. Método: Reconstrucción de los ligamentos pubouretrales, cardinales y úterosacros con acortamiento de su longitud y colocación de cinta de malla de polipropileno que permita la formación de colágeno y mejore los resultados a largo plazo. Resultados: Se incluyeron 15 pacientes con prolapso de órganos pélvicos, incontinencia urinaria, vulvodinia, nocturia, alteración del vaciamiento vesical y nocturia. Se realizó seguimiento al 1, 3 y 6 años. Se obtuvo diferencia estadísticamente significativa al año en la incontinencia urinaria de esfuerzo, dolor pélvico, alteración del vaciamiento y nocturia y prolapso ( p = 0,33, 0,033, 0,002 y 0,001 respectivamente). En el seguimiento a 6 años se evaluó el 20 % de la muestra inicial, 2 pacientes con recidiva de la alteración del vaciamiento y la incontinencia urinaria, ninguna con recidiva de prolapso. Vulvodinia: Se incluyeron 2 pacientes las cuales no tuvieron el síntoma a los 3 años de seguimiento. Conclusiones: La técnica propuesta es una alternativa para el tratamiento de la patología del piso pélvico y requiere aumentar el tamaño de la muestra para aumentar el aprendizaje de la técnica y tener mayor evidencia estadística de sus resultados a corto y largo plazo(AU)

Pelvic floor pathology is a multifactorial entity with a set of gynecological, urinary, fecal and pelviperineal sensitivity symptoms. The Integral Theory of Continence proposes a holistic treatment with the reconstruction of the ligaments of the pelvic floor. This proposed technique constitutes a surgical alternative that allows a global response to the symptoms reported by the patients. Method: Reconstruction of the pubourethral, cardinal and uterosacral ligaments with shortening of their length and placement of polypropylene mesh tape that allows collagen formation and improves long-term results. Results: 15 patients with pelvic organ prolapse, urinary incontinence, vulvodynia, nocturia, impaired bladder emptying and nocturia were included. Follow-up was performed at 1, 3 and 6 years. A statistically significant difference was obtained at one year in stress urinary incontinence, pelvic pain, impaired voiding, and nocturia and prolapse (p = 0.33, 0.033, 0.002, and 0.001, respectively). At 6-year follow-up, 20% of the initial sample was evaluated, 2 patients with recurrence of impaired voiding and urinary incontinence, none with recurrence of prolapse. Vulvodynia: 2 patients were included who did not have the symptom at 3 years of follow-up. Conclusions: The proposed technique is an alternative for the treatment of pelvic floor pathology. A larger sample is necessary to improve the learning curve of this technique and achieve greater statistical evidence of its outcomes at short and long term(AU)

Sensibilidad y especificidad de las escalas diagnósticas en la apendicitis aguda. Estudio prospectivo / Sensitivity and specificity of the diagnostic scales in acute appendicitis. Prospective study

La Apendicitis Aguda se manifiesta cuando existe inflamación del apéndice cecal, representando una de las más notables causas de abdomen agudo con pronóstico quirúrgico en el mundo. Existen sistemas de puntuaciones que se han generado para su comprobación, mediante técnicas no invasivas, de fácil aplicación y reproducción; destacando entre ellas las escalas de ALVARADO, RIPASA, AIR, entre otras. Objetivo: Comparar la sensibilidad y especificidad de las escalas AIR Vs. RIPASA para el diagnóstico de la Apendicitis Aguda en el Hospital General Nacional "Dr. Ángel Larralde", período enero 2020 ­ diciembre 2022. Materiales: Estudio observacional, descriptivo y evaluativo, prospectivo y de corte transversal. Muestra fue intencional no probabilística, cumpliendo con los criterios de inclusión. Para la recolección de datos, se empleó la observación directa como técnica y como instrumentos las escalas AIR y RIPASA. Resultados: Muestra conformada por 192 pacientes, sin predisposición de géneros. Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica AIR: 70%; 58,33%; 73,68%; 53,84%; 65,62%; RIPASA: 88,88%; 42,85%; 66,66%; 75%; 68,75%. Conclusiones: La exactitud diagnóstica para la escala de RIPASA fue ligeramente mayor que para AIR (68,75% vs. 65,62%), permitiendo afirmar que, en el grupo de estudio, resultó más conveniente la aplicación de la escala de RIPASA en pacientes sanos para el diagnóstico correcto de Apendicitis Aguda(AU)

Acute Appendicitis manifests when there is inflammation of the cecal appendix, representing one of the most notable causes of acute abdomen with surgical prognosis in the world. There are scoring systems that have been generated for verification, using non-invasive techniques that are easy to apply and reproduce; highlighting among them the scales of ALVARADO, RIPASA, AIR, among others.Objective : To compare the sensitivity and specificity of the AIR Vs. RIPASA scales for the diagnosis of Acute Appendicitis at the National General Hospital "Dr. Ángel Larralde", period January 2020 ­ December 2022. Materials: Observational, descriptive and evaluative, prospective and cross-sectional study. Sample was intentional, non-probabilistic, meeting the inclusion criteria. For data collection, direct observation was used as a technique and the AIR and RIPASA scales as instruments.Results : Sample made up of 192 patients, with no gender predisposition. Sensitivity, specificity, positive predictive value, negative predictive value, and AIR diagnostic accuracy: 70%; 58.33%; 73.68%; 53.84%; 65.62%; RIPASE: 88.88%; 42.85%; 66.66%; 75%; 68.75%.Conclusions : The diagnostic accuracy for the RIPASA scale was slightly higher than for AIR (68.75% vs. 65.62%), allowing us to affirm that, in the study group, the application of the RIPASA scale was more convenient in healthy patients for the correct diagnosis of Acute Appendicitis(AU)

Definición de continencia y factores pronósticos para la recuperación temprana de la continencia urinaria en la prostatectomía radical robótica con reconstrucción posterior del rabdoesfínter. Análisis post hoc de un ensayo clínico aleatorizado / Continence definition and prognostic factors for early urinary continence recovery in posterior rhabdosphincter reconstruction after robot-assisted radical prostatectomy. Post-hoc analysis of a randomised controlled trial

Introducción La incontinencia urinaria después de la prostatectomía radical es un efecto adverso con gran impacto en la calidad de vida. Actualmente no disponemos de medidas estandarizadas para su evaluación. La reconstrucción posterior del rabdoesfínter (RPR) puede mejorar la incontinencia urinaria precoz. Nuestro objetivo fue analizar diferentes definiciones y factores pronósticos de continencia urinaria precoz después de prostatectomía radical robótica (PRR).Materiales y métodos Realizamos un ensayo clínico aleatorizado (NCT03302169) incluyendo 152 pacientes con cáncer de próstata localizado sometidos a PRR y aleatorizados en anastomosis uretrovesical simple (grupo control) y RPR previa a la anastomosis (grupo RPR). La continencia urinaria se evaluó mediante cuestionarios específicos (EPIC-26 y ICIQ-SF), y la utilización de compresas (0-1 compresa y 0 compresas) a los 7, 15, 30, 90, 180 y 365 días tras la retirada de la sonda vesical. Se analizaron factores predictores para recuperación de continencia urinaria precoz.Resultados Se incluyeron 72 pacientes en el grupo control y 80 en el grupo RPR. Las características basales fueron similares entre grupos excepto el índice de masa corporal, mayor en el grupo RPR. La definición «0 compresas» fue la única que demostró beneficio de la RPR a los 30 días, con continencia del 33,8% en el grupo RPR y 18,1% en el grupo control, p=0,022, y a los 90 días, 58,8% y 43,1%, respectivamente, p=0,038. Los cuestionarios no mostraron diferencias entre grupos. La RPR fue el único factor predictor de continencia urinaria precoz.Conclusiones La RPR mejora las tasas de continencia urinaria precoz, pero la definición de continencia es determinante. El único factor predictor de continencia urinaria precoz fue la RPR (AU)

Introduction Urinary incontinence after radical prostatectomy (RP) is an adverse event with high impact on patient's quality of life. Nowadays there is no standardized method for urinary continence measurement. Posterior rhabdosphincter reconstruction (PRR) is a surgical step that can improve early urinary continence after RP. Our objective was to analyse different continence definitions and predictors of urinary continence recovery after robot-assisted RP (RARP).Materials and methods We conducted a double-blind, randomised controlled trial (NCT03302169) including 152 consecutive patients with localized prostate cancer subjected to RARP. Patients were randomised to single urethrovesical anastomosis (control arm) or PRR before urethrovesical anastomosis (PRR arm). Urinary continence was measured with the EPIC-26 and ICIQ-SF validated questionnaires, and pad use (0-1 pads and no pads), at 7, 15, 30, 90, 180 and 365 days after catheter removal. Prognostic factors for early urinary continence recovery were analysed.Results 72 patients were included in the control arm and 80 in the PRR arm. Baseline characteristics were similar between arms, except body mass index, which was higher in PRR arm. “No pad” was the only definition assessing the benefit of PRR at 30 days, 33.8% in PRR arm and 18.1% in control arm, p=0.022; and at 90 days, 58.8 and 43.1% respectively, p=0.038. Questionnaires did not detect differences in terms of continence recovery. PRR was the only predictor for early continence recovery, p=0.03.Conclusions PRR increased early urinary continence recovery after RARP. Continence definition was critical to assess benefit. The only predictive factor for early continence recovery was PRR (AU)

Continence definition and prognostic factors for early urinary continence recovery in posterior rhabdosphincter reconstruction after robot-assisted radical prostatectomy. Post-hoc analysis of a randomised controlled trial.

INTRODUCTION: Urinary incontinence after radical prostatectomy (RP) is an adverse event with high impact on patient's quality of life. Nowadays there is no standardized method for urinary continence measurement. Posterior rhabdosphincter reconstruction (PRR) is a surgical step that can improve early urinary continence after RP. Our objective was to analyse different continence definitions and predictors of urinary continence recovery after robot-assisted RP (RARP). MATERIAL AND METHODS: We conducted a double-blind, randomised controlled trial (NCT03302169) including 152 consecutive patients with localized prostate cancer subjected to RARP. Patients were randomised to single urethrovesical anastomosis (control arm) or PRR before urethrovesical anastomosis (PRR arm). Urinary continence was measured with the EPIC-26 and ICIQ-SF validated questionnaires, and pad use (0-1 pads and no pads), at 7, 15, 30, 90, 180 and 365 days after catheter removal. Prognostic factors for early urinary continence recovery were analysed. RESULTS: 72 patients were included in the control arm and 80 in the PRR arm. Baseline characteristics were similar between arms, except body mass index, which was higher in PRR arm. "No pad" was the only definition assessing the benefit of PRR at 30 days, 33.8% in PRR arm and 18.1% in control arm, p = 0.022; and at 90 days, 58.8 and 43.1% respectively, p = 0.038. Questionnaires did not detect differences in terms of continence recovery. PRR was the only predictor for early continence recovery, p = 0.03. CONCLUSIONS: PRR increased early urinary continence recovery after RARP. Continence definition was critical to assess benefit. The only predictive factor for early continence recovery was PRR.

Passagens / Passages / Pasajes / Passages

No texto, a autora se propõe a descrever o que considera os elementos centrais à prática analítica, aqueles que serão desenvolvidos durante a formação e ao longo da vida profissional: a captação do inconsciente do analisando, por meio da "antena", e a construção do que é devolvido para aquele, a linguagem. Os vários níveis de funcionamento mental do paciente e de intervenção do analista são ilustrados com exemplos clínicos. Assim, pretende-se abordar o ajuste necessário para captar as experiências somato-afetivas não elaboradas presentes no discurso, no brincar e no silêncio. Depois de comentar o conceito de continência, contido no binômio antena-linguagem, a autora traz algumas considerações pessoais sobre o tema do título, finalizando com o elemento de aventura incluído nas passagens da vida (e na formação), e na própria morte.

The author aims to describe what she considers the central elements to the analytical practice that should be developed during the training and throughout the analyst's professional life: the capture of the analysand's unconscious, through a kind of "antenna", and the construction of what is returned to him, the language. Various levels of mental functioning and interventions are illustrated with clinical examples, aiming at revealing the necessary adjustments to capture primitive somatic-affective experiences present in the analysand's discourse, in playing and in silence. After commenting on the concept of containment, included in the binomial antenna-language, the author brings some personal considerations on the theme of thetitle, ending with the element of adventure present in passages both in life (and in training) and death itself.

En el texto, la autora describe los elementos que considera centrales en la práctica analítica, que se desarrollarán durante la formación y a lo largo de la vida profesional: la captura del inconsciente del analizado a través de la "antena" y la construcción de lo que se le devuelve, el lenguaje. Ilustra los diversos niveles de funcionamiento mental e intervención del analista con ejemplos clínicos. Intenta abordar el ajuste necesario para plasmar las experiencias somato-afectivas no elaboradas presentes en el discurso, en el juego y en el silencio. Tras comentar el concepto de continencia presente en el binomio antena-lenguaje, la autora aporta consideraciones personales sobre el tema del título y finaliza con el elemento de la aventura existente en los pasajes de la vida (incluso en la formación) y en la propia muerte.

Dans le texte, l'auteur propose de décrire ce qu'elle considère comme les éléments centraux de la pratique analytique, ceux qui seront développés au cours de la formation et tout au long de la vie professionnelle : la capture de l'inconscient de l'analysant, à travers « l'antenne ¼, et la construction de ce qui lui est interprété, le langage. Les différents niveaux de fonctionnement mental du patient et l'intervention de l'analyste sont illustrés par des exemples cliniques, visant à révéler les ajustements nécessaires pour capturer les expériences somato-affectives non élaborées présentes dans le discours, dans le jeu et dans le silence. Après avoir commenté le concept de continence, contenu dans le binôme antenne-langage, l'auteur apporte quelques réflexions personnelles sur le thème du titre, se terminant par l'élément d'aventure inclus dans les passages de la vie (et de la formation psychanalytique), et dans la mort elle-même.

Radical retropubic prostatectomy: Preservation of urinary continence. / La prostatectomía radical retropúbica: preservación de la continencia urinaria.

OBJECTIVE: Historical review of procedures and maneuvers described in the literature to preserve-increase urinary continence after retropubic prostatectomy. MATERIAL AND METHOD: Review of the original articles on the design of maneuvers for the preservation of urinary continence. RESULTS: Numerous maneuvers have been described attempting to preserve-increase urinary continence after prostatectomy. They can be grouped into preservation of puboprostatic ligaments, bladder neck, striated sphincter or trigonal innervation, construction of a neourethra, suspension of the anastomosis or the dorsal venous complex and intussusception of the bladder neck. CONCLUSION: There is no ideal maneuver for preserving-increasing urinary continence after retropubic prostatectomy, as there is no well-conducted work with any of these techniques that confirm their efficacy.

Retzius-sparing robot-assisted radical prostatectomy: Perioperative and immediate continence outcomes of an initial series. / Prostatectomía radical robot-asistida con preservación del espacio de Retzius: resultados perioperatorios y de continencia inmediata en una serie inicial.

OBJECTIVE: The objective of this work is to present initial perioperative, immediate continence and oncological results in a series of 25 prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy. MATERIAL AND METHODS: We retrospectively analyzed a series of 25 patients treated with Retzius-sparing robot-assisted radical prostatectomy for cT1-T2b prostate cancer between 2018-2019. The 5 stages of surgery are described. We make a descriptive statistic of our initial series and its outcomes in terms of immediate continence, defined as the use of 0 pad/diapers or 1 safety pad/diaper every 24 hours, one week after catheter removal. RESULTS: Median follow-up, 6 months (3-18). Median PSA, 6.1 ng/ml (4-14.3). All surgeries were performed through a posterior intrafascial approach, and bilateral nerve-sparing was carried out in 84% of the cases. Affected surgical margins were present in 28%, being the apex the most frequent site of affectation. Surgical complications: 1 (4%) patient required transfusion of blood products in the immediate postoperative period. Mean hospital stay was 48 hours. Functional outcomes: 80% of the patients present immediate continence. 80% of continent patients do not require the use of any safety pads/diapers. Oncological outcomes: 84% are free of biochemical-progression in a median follow-up of 6 months. CONCLUSIONS: Initial functional results in terms of immediate continence are very satisfactory in patients who have undergone Retzius-sparing robot-assisted radical prostatectomy without negative impact on prognosis.

A escuta polifônica no atendimento psicanalítico de adolescentes / The polyphonic listening in psychoanalytic care of adolescents / La escucha polifónica en el tratamiento psicoanalítico de adolescentes / L'écoute polyphonique dans le soins psychanalytiques des adolescents

A autora evidencia a adolescência e suas metamorfoses no corpo e na vida emocional, e os conflitos da complexa passagem da infância à adolescência. Compartilha a experiência analítica vivida com dois adolescentes, Jacinto e Íris, que têm em comum o casal parental que apresenta prejuízo em sua constituição desencadeando a inserção destes num universo fantástico e perverso. A escuta polifônica amplia o conhecimento da psicanalista quando se interessa em conhecer assuntos, como jogos e teorias, que estavam distantes de seu repertório cotidiano.

The author highlights the adolescence and its metamorphoses in the body and emotional life, and the conflicts of the complex passage from childhood to adolescence. She shares the analytical experience lived with two teenagers, Jacinto and Iris, who have in common the parental couple that presents impairment in their constitution triggering their insertion in a fantastic and perverse universe. Polyphonic listening broadens the psychoanalyst's knowledge when she is interested in knowing subjects such as games and theories that were far from her everyday repertoire.

El autor destaca la adolescencia y sus metamorfosis en el cuerpo y la vida emocional, y los conflictos del complejo paso de la infancia a la adolescencia. Comparte la experiencia analítica vivida con dos adolescentes, Jacinto e Iris, que tienen en común la pareja parental que presenta un impedimento en su constitución que desencadena su inserción en un universo fantástico y perverso. La escucha polifónica amplía el conocimiento del psicoanalista cuando está interesada en conocer temas como juegos y teorías que estaban lejos de su repertorio cotidiano.

L'auteur met en évidence l'adolescence et ses métamorphoses dans le corps et la vie affective, ainsi que les conflits du passage complexe de l'enfance à l'adolescence. Elle partage l'expérience analytique vécue avec deux adolescents, Jacinto et Iris, qui ont en commun le couple parental qui présente une altération de leur constitution déclenchant leur insertion dans un univers fantastique et pervers. L'écoute polyphonique élargit les connaissances de la psychanalyste lorsqu'elle s'intéresse à des sujets tels que les jeux et les théories qui étaient loin de son répertoire quotidien.

Technical features and the demonstrated advantages of the Retzius sparing robotic prostatectomy.

OBJECTIVE: Robot-assisted laparoscopic  radical prostatectomy (RARP) is nowadays considered  the main surgical option for localized prostate cancer (PCa). We recently developed a new approach for RARP  avoiding all the Retzius structures involved in continence  and potency preservation, the so called Retzius-sparing  technique (RSP). The objective of the paper is to report technical aspects and functional results of RSP.  METHODS: We evaluated our data and available literature  regarding RSP, functional results and advantages.  RESULTS: RSP is oncologically safe and guarantee high early continence rates. CONCLUSION: Long-term, prospective, comparative,  and possibly randomized studies are needed but RSP is  now spreading all over the world thanks to the different advantages that offers to patients. The most recognized benefit is surely the achievement of early continence, as well documented in multiple studies and papers, without compromising the oncological outcomes.

ARTICULO SOLO EN INGLES. OBJETIVO: La prostatectomía radical laparoscópica  asistida por robot (PRAR) se considera hoy  en día la principal opción quirúrgica para el cáncer de próstata localizado. Recientemente desarrollamos un  nuevo abordaje para la PRAR evitando todas las estructuras  del Retzius involucradas en la conservación de la continencia y la potencia, la conocida como técnica de prostatectomía conservadora del Retzius (PCR). El objetivo  de este artículo es comunicar los aspectos técnicos  y funcionales de la PCR. MÉTODOS: Evaluamos nuestros datos y la literatura disponible  sobre PCR, resultados funcionales y ventajas. RESULTADOS: La PCR es oncológicamente segura y garantiza  unas tasas altas de continencia precoz. CONCLUSIONES: Son necesarios estudios a largo  plazo, prospectivos, comparativos y posiblemente aleatorizados pero la PCR está actualmente extendiéndose  por todo el mundo gracias a las diferentes ventajas que ofrece a los pacientes. El beneficio más reconocido es  seguramente la consecución de continencia precoz, bien documentada en múltiples estudios y artículos, sin  compromiso de los resultados oncológicos.

Objective assessment of early urinary continence by analysis and visualisation of intraoperative variables of radical robotic prostatectomies with a video editor. / Valoración objetiva de la continencia urinaria precoz mediante el análisis y la visualización de variables intraoperatorias de prostatectomías radicales robóticas con un editor de vídeos.

INTRODUCTION: UI after RP is a factor that has a major impact on patients' quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. MATERIAL AND METHODS: a retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ ≤ 7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. RESULTS: In our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year. In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (P≤.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. CONCLUSION: In conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence.

High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience. / Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo.

INTRODUCTION: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. MATERIAL AND METHODS: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. RESULTS: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). CONCLUSION: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.

Sonhando na sessão: comunicação primitiva e constituição do espaço psíquico / Dreaming in the session / Soñando en la sesión / Rêver dans la séance

Neste trabalho, um paciente que nunca sonhou começa a dormir e a sonhar nas sessões, sempre acompanhado pelas interpretações da analista, que visam a articular as cenas desconexas dos sonhos, para que ele possa dar significado a suas experiências emocionais e se apropriar de seus recursos psíquicos - desde a discriminação de seus impulsos e sentimentos, até a consciência de como utilizá-los em suas relações objetais. Em análises de pacientes cuja comunicação é predominantemente muito primitiva, a autora propõe que o analista privilegie a escuta e a apropriação dos recursos psíquicos. Ela acredita que, se o analista favorecesse prematuramente algumas interpretações nas quais fosse ressaltada a transferência, a análise resultaria em impasses, e isso poderia comprometer a constituição e ampliação do espaço psíquico do analisando, procedimento básico para futuros desenvolvimentos. Serão apresentadas vinhetas clínicas referentes a um paciente de 47 anos, em análise há cinco. Nesse material, as interpretações visam à apropriação, pelo paciente, de seus recursos singulares. Essas interpretações predominam sobre as transferenciais, as quais, pouco a pouco, podem surgir.

This paper is about a patient who had not dreamed until he started sleeping and dreaming during the psychoanalytic sessions. The analyst makes interpretations on these dreams in order to articulate the disconnected scenes of the patient's dreams. It enables this patient to give meaning to his emotional experiences and hence he becomes capable of appropriating his psychological resources: from his impulses and feelings to his awareness of how to apply them in object relationships. In the analysis of patients whose communication is mostly very primitive, the author suggests that psychoanalysts should prioritize the listening and the patient's appropriation of psychological resources. If the analyst prematurely preferred some interpretations that emphasized transference, the analysis would result in impasses, the author believes. This preference might compromise both constitution and expansion of the analysand's psychological space which is the basic process for future development. The author brings clinical vignettes of a 47 year old patient who has been in analysis for 5 years. In these vignettes, the purpose of the interpretations is the patient's appropriation of his unique resources. These analyst's interpretations prevail over transferential interpretations which may gradually happen later.

En este trabajo, la autora presenta el caso de un paciente, que antes nunca había soñado, que comienza a dormir y a soñar en las sesiones, acompañado por las interpretaciones de la analista dirigidas a articular las escenas desconectadas de los sueños, para que él pueda dar significado a sus experiencias emocionales y apropiarse de sus recursos psíquicos - desde la discriminación de sus impulsos y sentimientos, como también, la conciencia del uso que hace de ellos en las relaciones objetales - constituyendo, así, su espacio mental. En análisis de pacientes que tienen un tipo de comunicación muy primitiva, la autora propone que el analista priorice la escucha y la apropiación, por parte del paciente, de sus recursos psíquicos. Desde su punto de vista, si el analista hiciera, prematuramente, interpretaciones basadas en la transferencia, eso no sólo podría llevar a impasses en el análisis, como también podría comprometer la constitución del espacio psíquico del paciente, que es fundamental para que ocurran desarrollos futuros. Presenta material clínico de un paciente de 43 años, que está en análisis hace cinco años. En este material, las interpretaciones están dirigidas a que el paciente pueda apropiarse de sus recursos psíquicos singulares. Ese tipo de interpretaciones predominan sobre las interpretaciones transferenciales que irán surgiendo poco a poco.

Dans ce travail, un patient qui n'a jamais rêvé commence à dormir et à rêver pendant les séances, accompagné toujours des interprétations de l'analyste, qui visent à articuler les scènes disjointes des rêves, afin qu'il puisse donner un sens à ses expériences émotionnelles et s'approprier de ses ressources psychiques - dès la discrimination de ses impulsions et de ses sentiments, jusqu'à la prise de conscience de comment les utiliser dans ses relations d'objet. Dans les analyses de patients dont la communication est surtout très primitive, l'auteur propose que l'analyste privilégie l'écoute et l'appropriation des ressources psychiques. Elle croit que, si l'analyste favorisait prématurément certaines interprétations dans lesquelles le transfert était mis en relief, l'analyse entraînerait des impasses et cela pourrait compromettre la constitution et l'expansion de l'espace psychique du patient, une procédure de base pour des développements futurs. On présente des vignettes cliniques concernant un patient âgé de 43 ans, qui est en cours d'analyse il y a 5 ans. Dans ces exemples, les interprétations visent à que le patient s'approprie de ses propres ressources singulières. Ces interprétations prédominent sur les transférentielles qui peuvent surgir peu à peu.

Ivy: criando apoios internos / Ivy: creating an internal support / Ivy: creando apoyos internos / Ivy: la création des appuis internes

Na forma de um roteiro cênico, este trabalho apresenta uma paciente que foi pouco reconhecida e investida, desde sua infância, com um olhar que a valorizasse, o que trouxe importantes questões na área narcísica e consequentes defesas. Por meio do relato clínico pretende-se evidenciar o trabalho do percurso analítico na busca por uma integração e continência. Acompanhando a paciente e o seu relato de sonhos, a analista percebeu a falta de conexão entre a pessoa que os relatava e a que os sonhava, incapaz de viver suas emoções, apesar da riqueza onírica. Intrigada por esse outro self que aparecia, através de contundentes sonhos noturnos, revela-se a importância da escuta analítica para a linguagem pouco simbólica, com consequente falta de representação. A autora baseia-se em autores como Freud, Bion, Ogden e Winnicott para aproximar-se do conceito do irrepresentável.

In a theatrical format, this paper presents a patient who has had almost no recognition nor appreciation since her childhood. Significant issues in the narcissistic area and consequent defenses have arisen from this situation. The author's purpose is to show, through a clinical vignette, the psychoanalytic path towards achieving integration and continence. The analyst notices, when she listens to the patient talk about her dreams, a lack of connection between the person who tells the dream and the person who dreams the dream. This person is unable to experience her emotions, despite the oneiric richness of her dreams. The author is intrigued by this other self which emerges from these stunning, night dreams. This paper reveals the importance of psychoanalytic listening for a less symbolic language and therefore lack of representation. Based on authors such as Freud, Bion, Ogden, and Winnicott, the author deals with the concept of the "unrepresentable".

Como si fuera el relato de un guión teatral, este trabajo presenta a una paciente que fue poco reconocida e investida con una mirada que la valorizara, y eso provocó importantes cuestiones en el área narcisista y, consecuentemente, en la construcción de defensas. A través de este relato clínico, la autora se propone mostrar el camino seguido en el proceso analítico en la búsqueda de una mayor integración y continencia. Acompañando a la paciente y al relato de sus sueños, la analista percibió una falta de conexión entre la persona que los relataba y la que los soñaba, incapaz de vivir sus emociones, a pesar de la riqueza de su producción onírica y se sintió intrigada por ese otro self que aparecia, a través de los contundentes sueños nocturnos. Este trabajo revela la importancia de la escucha analítica para un lenguaje poco simbólico y, consecuentemente, con falta de representación. Para aproximarse al concepto de lo irrepresentable, la autora se basa en autores como Freud, Bion, Ogden y Winnicott

Sous la forme d'un scénario, l'auteur présente une patiente qui n'a pas été reconnue et investie par un regard qui puisse la valoriser, ce qui a entraîné des questions importantes dans le domaine narcissique et les défenses consécutives. Le rapport clinique met en évidence le parcours psychanalytique à la recherche d'intégration et de contention de la patiente. En suivant la patiente et son récit de rêves, l'analyste constate un manque de connexion entre la personne qui rêve et la personne qui raconte, incapable de vivre ses émotions, malgré la richesse onirique. L'auteur, intriguée par cet autre self qui apparaît dans des rêves nocturnes inquiétants, met l'accent sur l'importance de l'écoute analytique dans ce cadre où le langage est peu symbolique, ce qui entraine le manque de représentation. L'auteur utilise comme référence le concept de l'irreprésentable chez Freud, Bion, Ogden et Winnicott.

Banda suburetral libre de tensión transobturadora versus single-incision sling para el tratamiento de la incontinencia urinaria de esfuerzo: seguimiento a 2 años / Transobturator tape versus single-incision sling for the treatment of stress urinary incontinence

Objetivos: Determinar la tasa de curación objetiva/subjetiva y complicaciones del tratamiento de incontinencia urinaria de esfuerzo con banda suburetral transobutadora y single-incision sling. Métodos: Estudio retrospectivo de pacientes operadas de incontinencia urinaria de esfuerzo (hipermovilidad uretral) con banda suburetral transobturadora (n: 37) y single-incision sling (n: 44) entre enero-2012 y enero-2015. Si se asociaba corrección de prolapso de órganos pélvicos, se colocaba banda transobturadora (TVT-O/ TOT) con internación. Si no precisaba corregir prolapso, se insertaba single-incision sling ambulatoriamente. Las evaluaciones fueron al mes, 6 meses y 1 año. El contacto a 2 años fue telefónico. De 37 bandas transobturadoras completaron seguimiento 35 a 1 año y 26 a 2 años. De 44 single-incision sling, completaron seguimiento 42 a 1 año y 19 a 2 años. Resultados: La edad media para transobturadoras fue superior: 65±9,7 vs 58,2±11,3 (p=0,005). Transobturadoras demostraron más prolapso asociado: 87,8% vs 63,3% (p=0,042) y mayor tiempo quirúrgico (minutos): 81,07±31,27 vs 36,79±11,09 (p=0,000). Hubo mayor morbilidad en transobturadoras, sin diferencias significativas. La continencia al año fue: 80% transobturadoras vs 83% single-incision sling (p=0,706) y a 2 años: 84% vs 79% (p=0,623). Se encontraban satisfechas al año: 80% transobutradoras vs 85,7% single-incision sling (p=0,586) y a 2 años: 88,5% vs 78,9% (p=0,512). Conclusiones: Single-incision sling presentan tasas de éxito y satisfacción similares a bandas transobturadoras, con menor morbilidad, coste y tiempo operatorio, pudiendo ser de primera elección cuando no exista prolapso sintomático asociado.

Objectives: To determine objective and subjective cure rate and complications of stress urinary incontinence treatment with transobturator tape and single-incision sling. Methods: We performed a retrospective study including patients diagnosed of stress urinary incontinence, treated surgically either with transobturator tape (n: 37) or with single-incision sling (n: 44), between January 2012 and January 2015. If pelvic organ prolapse was associated, transobturator route was preferred requiring patient hospitalization. If this correction was not needed, we performed single-incision sling, as an ambulatory procedure. Follow up visits were scheduled at 1, 6, 12 months after surgery and a telephone interview at 24 months. Results: Mean age was higher in transobturator group: 65±9.7 vs 58.2±11.3 (p=0.005). A statistically significant difference between the two groups was found in operating time (minutes): 81.07±31.27 vs 36.79±1.09 (p=0.000) and pelvic prolapse associated: 87.8% vs 63.3% (p=0.042). Morbidity rate was higher in the transobturator group, but without significance. After 1 year follow-up, there were no significant differences between the transobturator and the single-incision groups regarding continence (80% vs 83%; p=0.706) and satisfaction (80% vs 85.7%; p=0.586). We found similar results at 24 months telephonic interview. Conclusions: Single-incision slings are comparable to transobturator tapes in 12 and 24 months success rates and satisfaction, with significantly less morbidity, costs and operating time, becoming first line option when no pelvic prolapse is associated.

Indicação de terapia familiar psicanalítica para uma família com uma criança obesa / Indication of psychoanalytic family therapy for a family with a child obese / Indicación de terapia familiar psicoanalítica para una familia con un niño obeso

O processo terapêutico de uma terapia familiar psicanalítica com criança que sofre de obesidade coloca em evidência a complexidade subjacente à esta problemática. A dinâmica da família discutida neste artigo é caracterizada por movimentos de indiferenciação entre a criança e a mãe, acompanhada de uma falha de continência familiar. Esta falha se especifica pelo surgimento de elementos brutos, traços de uma problemática incestuosa e de violência conjugal. O objetivo dessa terapia não se caracteriza pela busca de conhecimento sobre os eventos vividos pela família, mas principalmente por uma elaboração grupal dos elementos percebidos (como o caos e a confusão) no aqui e agora de cada sessão, possibilitando aos membros da família instaurar o movimento de separação e de individuação.

The therapeutic process of a family therapy, with a child suffering from obesity, has demonstrated the complexity of such a pathology. The characteristic of the family dynamics is a lack of differentiation mother and child, together with a failure of the family holding. This failure of the family holding is specified by the occurrence of gross elements, the signs of an incestuous problem and domestic violence. The aim of this therapy is not so the presentation of these life events but more a group formulation of these various elements (like chaos and confusion) which occur in the « hic and nunc ¼ of the course of the therapy, thus enabling the process of separation and individuation within the members of the family.

El proceso terapéutico de una terapia familiar psicoanalítica con niños que sufren de obesidad pone de relieve la complejidad subyacente a esta cuestión. La dinámica de la familia mencionada en este artículo se caracteriza por movimientos de indiferenciación entre la niña y la madre, acompañadospor un fallo de la continencia familiar. Este fallo se especifica mediante el aumento de elementos crudos, vestigios de una problemática incestuosa y de la violencia doméstica. El objetivo de esta terapia no se caracteriza por la búsqueda del conocimiento acerca de los eventos experimentados por la familia, pero sobre todo para una elaboración grupal de preparación de los elementos percibidos (por ejemplo, el caos y la confusión) en el aquí y ahora de cada sesión, permitiendo a los miembros de la familia establecer el movimiento de separación e individuación.

Rodas de conversa entre a educação e a psicanálise / Conversation circles involving education and psychoanalysis

Os autores apresentam a experiência de um trabalho em parceria de um grupo de psicanalistas da Sociedade Psicanalítica de Porto Alegre (SPPA) com a Secretaria Municipal de Educação de Porto Alegre (SMED) junto às instituições de educação infantil. Na atividade (Rodas de Conversa), participam os profissionais envolvidos na educação cotidiana das crianças em comunidades de alta vulnerabilidade social. Ressaltam que, a partir de uma atitude de acolhimento e continência das vivências compartilhadas, mais do que respostas/soluções às perguntas, os participantes conversam sobre as situações com vistas a encontrar alternativas possíveis e a tolerar não ter condições para resolver todos os problemas, a ouvir o que o outro tem a dizer e a aprender com a narrativa do outro. Observa-se que a autoestima dos educadores se fortalece percebendo que são capazes de avançar em sua trajetória pessoal e profissional. Finalizam trazendo questionamentos sobre o alcance do trabalho realizado, reconhecendo que segue sendo uma atividade em construção nestes nove anos.

The authors report on the experience of a series of meetings held by a group of psychoanalysts from the Psychoanalytical Society of Porto Alegre (SPPA) in collaboration with the Municipal Secretariat for Education of Porto Alegre (SMED) together with early childhood education institutions. Professionals involved on a daily basis in the education of children from communities with a high degree of social vulnerability took part in this activity (Conversation Circles). They highlight that, by embracing and containing shared experiences, rather than merely answering/solving questions, the participants discussed the situations with the aim of finding possible alternatives and accepting the inability to solve all problems, and also of listening to what the other has to say and of learning from the other's narrative. It was observed that the educators' self-esteem increased as they realized to be able to make steps forward in their personal and professional trajectory. The authors conclude by raising questions about the scope of the work carried out, while recognizing it remains as an activity in progress over the past nine years(AU)

Los autores presentan la experiencia de un trabajo conjunto de un grupo de psicoanalistas de la Sociedade Psicanalítica de Porto Alegre (SPPA) y de la Secretaría Municipal de Educación de Porto Alegre (SMED) en instituciones de educación inicial. En la actividad (Ruedas de Diálogo), participaron profesionales involucrados en la educación cotidiana de niños pertenecientes a comunidades de alta vulnerabilidad social. Resaltan los autores que, a partir de una actitud de acogida y contención de las vivencias compartidas, más que respuestas/soluciones para sus preguntas, los participantes conversaron sobre las situaciones con vistas a encontrar alternativas posibles y a tolerar no tener condiciones para solucionar todos los problemas, a escuchar lo que el otro tiene para decir y a aprender con el relato del otro. Se observó que la autoestima de los educadores se fortalece cuando perciben que son capaces de avanzar en su trayectoria personal y profesional. Esta presentación culmina con planteamientos sobre el alcance del trabajo realizado, reconociendo que sigue siendo una actividad en construcción en estos nueve años(AU)

Representação de registros primitivos através da peça teatral “cru” / The representation of primitive registers through the play “cru”

A autora relata a experiência de assistir à peça teatral Cru, e coloca o leitor em contato com a teoria de Wilfred Bion, com o objetivo de compreender os sentimentos primitivos provocados na autora e na plateia. No decorrer do trabalho, serão descritos trechos da peça teatral, os quais serão aprofundados com pensamentos psicanalíticos de Bion, Freud, Melanie Klein, entre outros(AU)

The author reports the experience of watching the play Cru, and puts the reader in touch with the Wilfred Bion’s theory with the objective of understanding the primitive feelings caused in both the author and the audience. In this paper, the author will describe some excerpts of the play, which will be deepened with psychoanalytic thoughts of Bion, Freud, Melanie Klein, among others(AU)

Enuresis en niños: frecuencia y antecedentes familiares / Enuresis in children: frequency and family history

La enuresis es una patología frecuente en pediatría, con potencial impacto en la calidad de vida del niño y sus padres. En Chile no existe literatura respecto al potencial efecto de esta patología en la dinámica familiar. El objetivo de este trabajo fue estimar la frecuencia de enuresis en una población de nivel socioeconómico medio-alto y describir los factores de riesgo familiares asociados y grado de preocupación de los padres respecto al tema. Método. Entre 2010 y 2011 se aplicó una encuesta voluntaria a los padres de pacientes atendidos ambulatoriamente en Clínica Las Condes. Se registraron los antecedentes de enuresis de los padres, número y edad de los hijos, número de hijos con enuresis, preocupación de los padres al respecto. Resultados. Se analizaron 334 familiares, que correspondieron a 499 niños mayores de cinco años, de los cuales 91 (18,2%) presentaron enuresis. El 57% de los pacientes con enuresis tenía antecedentes familiares, 58% correspondía al padre, 36% a la madre y 6% a ambos padres. El 51% de los padres reveló preocupación por este hecho. El grupo etario más afectado correspondió a niños de entre cinco y nueve años con un 38,8% de frecuencia, porcentaje bastante mayor al señalado por la literatura. Respecto a la herencia, un 57% tenía antecedentes familiares de padre y/o madre con enuresis.

Enuresis is a common condition in children, with potential impact on quality of life of children and their parents. In our country there is no literature on the potential impact of this disease on family dynamics. The aim of this study was to estimate the frequency of bedwetting in a population of middle-high socioeconomic level and describe the risk factors associated, family and degree of parental concern regarding the issue. Method: between 2010 and 2011 were surveyed parents of voluntary outpatients seen at Clinica Las Condes. We recorded the history of bedwetting parents, number and age of children, number of children with enuresis, parental concern about it. Results: We analyzed 334 families, which corresponded to 499 children over five years old., Ninety one (18.2%) had enuresis. 57% of patients with enuresis had a family history, 58% belonged to the father, the mother 36% and 6% both parents. 51% of parents showed concern about this. The most affected age group accounted for children between 5 and 9 years with a 38.8% rate, far higher percentage than that reported by the literature. Regarding inheritance, 57% had a family history of father and/or mother with enuresis.