Dual Mobility Cups as the Routine Choice in Total Hip Arthroplasty.

Background and Objectives: Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of DMC in elective surgeries. Our aim is to assess the trend of DMC indications in THA as well as the incidence of their dislocation. Materials and Methods: We retrospectively reviewed all patients undergoing THA with DMC during the years 2015 and 2021. The original indication for DMC included patients sustaining neck of femur fractures (NOF#) and associated risk factors for dislocations. Five years later, DMC was considered our standard of care in total hip arthroplasty. The approach (anterolateral or posterolateral) was chosen by the surgeon according to his/her preferences, as was the implant. Data collected included patients' demographics, diagnosis, admission time, surgical approach, cup models, and inclination and complications. Patients sustaining a hip dislocation were prospectively reviewed and assessed for treatment received, new dislocations, and need for surgical revision. Two groups were created for the analysis according to the presence or absence of dislocation during follow-up. Results: In the analysis, 531 arthroplasties were included (mean age 72.2 years) with a mean follow-up of 2.86 years. The trend of indications for DMC increased from 16% of THA in 2015 to 78% of THA in 2021. We found a total of 8 dislocations (1.5%), none of them associated with elective surgery. Closed reduction was unsatisfactory in four cases (50%). There was one case of intraprosthetic dislocation. Dislocations were associated to smaller heads (22 mm) (1.5% vs. 25%, p = 0.008) and cups (51.2 mm vs. 48.7 mm, p = 0.038) and posterior approach (62.5% vs. 37.5%, p = 0.011). Conclusion: Dual mobility cups are a great option to reduce the risk of dislocation after a THA both in the neck of femur fractures and elective cases. The use of an anterolateral approach in THA after a neck or femur fracture might considerably decrease the risk of dislocation.

Prospective nonrandomized study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy to magnetic resonance imaging with subsequent MRI-guided biopsy in biopsy-naïve patients.

BACKGROUND: To evaluate the diagnostic efficacy in cancer prostate (PCa) of Multiparametric prostate magnetic resonance imaging (mp-MRI) targeted biopsy compared to standard systematic transrectal ultrasound-guided biopsy (TRUSGB) in biopsy-naïve patients. METHODS: A total of 168 biopsy-naïve men with clinical suspicion of PCa due to elevated PSA levels and/or an abnormal digital rectal examination were consecutively enrolled from July 2011 to July 2014. All patients underwent TRUSGB. Patients with equivocal (Pi-rads 3) or suspicious lesion (Pi-rads 4-5), were additionally biopsied using two cores, by the same operator (cognitive technique). RESULTS: Among the 168 cases, mp-MRI was equivocal for PCa (Pi-rads 3) in 46 subjects (27.4%) and suspicious (Pi-rads 4, 5) in 40 cases (23.8%). Of the 69 patients with PCa, standard TRUSGB showed Gleason ≥7 in 75% of patients with Pirads 3 and 77.8% in cases with Pirads 4-5 on mp-MRI. Among the 40 patients with Pi-rads 4-5 lesion on the MRI, cognitive mp-MRI-guided biopsy (MRCGB) detected a higher number of cases of PCa with a Gleason score equal or superior to 7 (90%) with a higher negative predictive value (97.5%) than cases with Pi-rads 3 lesion or subjects with TRUSGB alone. CONCLUSIONS: mp-MRI followed by selective biopsy seems to be a valuable tool to improve the diagnosis of intermediate and high risk PCa compared to standard TRUSGB.

Metástasis en pene de carcinoma de recto. Presentación de un caso y revisión de la literatura / Penile metastasis of rectal carcinoma. Case report and bibliographic review

OBJETIVO: Aportación de un caso de metástasis peneana en un paciente con carcinoma rectal.MÉTODOS: Paciente de 70 años remitido a nuestra consulta por el hallazgo de “induraciones en el pene” habiéndose diagnosticado de carcinoma rectal 18 meses antes. Tras evaluación física es sometido a biopsia de dichas lesiones.RESULTADOS: El resultado del análisis anatomo-patológico de la biopsia de glande fue de “metástasis de adenocarcinoma rectal”CONCLUSIONES: Las metástasis en el pene son raras, y, habitualmente se producen en el contexto de enfermedad oncológica avanzada(AU)

OBJECTIVE: Contribution of a case of penile metastasis in a patient with metastatic rectal carcinoma.METHODS: A 70-Year-old patient was referred to our consultation after the discovery of “penis indurations” having been diagnosed of rectal carcinoma 18 months before. After physical examination penile biopsies were carried out.RESULTS: The pathological results of the Glans biopsy was “rectal adenocarcinoma metastasis”.CONCLUSIONS: Metastases in the penis are rare, and usually occur in the context of advanced oncological disease(AU)

Bladder schistosomiasis: case report and bibliographic review.

OBJECTIVE: To report a new case of bladder schistosomiasis. METHODS: A 21-year-old patient came to our consultation with gross hematuria several weeks before, existing reddish lesions in the cystoscopy that suggested the existence of an atypical bladder tumor. RESULTS: After intense blood and urine test, ultrasonography and intravenous urography, transurethral resection of bladder was performed and the diagnosis on histological examination was bladder schistosomiasis. CONCLUSIONS: Given the high prevalence of schistosomiasis in the sub-Saharan countries and later clinical epidemiologic implications, the appearance of macro or microscopic hematuria in black race immigrants, or even any urinary symptoms, it is necessary a complete evaluation, at least with a parasitological analysis (being the bilharziasis the most probably reason). The patients who have suffered severe urinary schistosomiasis must complete long-term follow-up to prevent bladder carcinoma.

Esquistosomiasis vesical: A propsito de un caso y revisión de la literaura / Bladder schistosomiasis: case report and bibliographic review

OBJETIVO: Aportación de un nuevo caso de esquistosomiasis vesical.MÉTODOS: Paciente de 21 años que acude a nuestra consulta con hematuria de varias semanas de evolución, observando en la cistoscopia la existencia de lesiones rojizas sobreelevadas que sugieren la existencia de un tumor vesical atípico.RESULTADOS: Tras ser sometido a un análisis de sangre y orina rigurosos, pruebas de imagen y, posteriormente, resección transuretral vesical el paciente es diagnosticado en el estudio anatomopatológico de esquistosomiasis vesical. CONCLUSIONES: Dada la elevada prevalencia de la esquistosomiasis en los países subsaharianos y sus posteriores implicaciones clínicoepidemiológicas, la aparición de una hematuria macro o microscópica en inmigrantes de raza negra, o incluso la aparición de cualquier sintomatología urológica, necesita una evaluación completa, al menos con un estudio parasitológico que considere la bilharziasis como la causa más probable.Los pacientes que han padecido esquistosomiasis urinaria severa deben someterse a un seguimiento a largo plazo para prevenir y detectar el desarrollo de carcinoma vesical(AU)

OBJECTIVE: To report a new case of bladder schistosomiasis.METHODS: A 21-year-old patient came to our consultation with gross hematuria several weeks before, existing reddish lesions in the cystoscopy that suggested the existence of an atypical bladder tumor.RESULTS: After intense blood and urine test, ultrasonography and intravenous urography, transurethral resection of bladder was performed and the diagnosis on histological examination was bladder schistosomiasis.CONCLUSIONS: Given the high prevalence of schistosomiasis in the sub-Saharan countries and later clinical epidemiologic implications, the appearance of macro or microscopic hematuria in black race immigrants, or even any urinary symptoms, it is necessary a complete evaluation, at least with a parasitological analysis (being the bilharziasis the most probably reason).The patients who have suffered severe urinary schistosomiasis must complete long-term follow-up to prevent bladder carcinoma(AU)

[Cerebellum and lower urinary tract]. / Cerebelo y tracto urinario inferior.

OBJECTIVES: To review the role of cerebellum on the lower urinary tract dynamics. METHODS: Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS: We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS: It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase.

Cerebelo y tracto urinario inferior / Cerebellum and lower urinary tract

OBJETIVO: Revisar el papel del cerebeloen la dinámica del tracto urinario inferior. MÉTODO: Metodología anatomofuncional que incluyeestudio estructural, funcional y de neurotransmisores. RESULTADOS: Se describen las complejas conexionesdel cerebelo y su influencia sobre la función del tractourinario inferior. CONCLUSIONES: Es sorprendente la interrelación funcionalentre cerebelo y tracto urinario inferior, ejerciendoun papel modulador inhibitorio durante la fase dellenado y facilitador durante la fase de vaciado (AU)

OBJECTIVES: To review the role of cerebellum on the lower urinary tract dynamics. METHODS: Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS: We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS: It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase (AU)

[Clinico-urodynamic correlation in the hereditary ataxias]. / Correlación clínico-urodinámica en las ataxias hereditarias.

OBJECTIVES: To evaluate lower urinary tract functional symptoms in a series of patients with ataxia and to determine by urodynamic studies the kind of bladder-urethra neurological dysfunction in each case. We posed the question if the clinical picture could be enough to establish the diagnosis and therapeutic management of these patients with hereditary ataxia, or on the contrary it would be necessary to perform urodynamic studies in all cases. METHODS: Due to the low incidence of hereditary ataxias and patients' mobility it was necessary to recruit patients from various hospitals. The urodynamic study protocol employed in this study included 1) Evaluation of urinary symptoms; 2) Neurological physical examination; 3) Flowmetry with post void residual; 4) Cystomanometry; and 5) Perineal electromyography. We analyzed the relationship between urinary symptoms and urodynamic diagnosis, considering variables such as age, gender, type of ataxia, and time of evolution of the disease. RESULTS: The series includes 34 patients with ataxia and urinary symptoms, 14 cases of Friedreich's ataxia (FA) (41.2%) and other 20 cases of other various forms of ataxia we name non-Friedreich's (NF) (58.8%). Mean age was 37.2 years in FA and 50 years in NF (p < 0.05). Mean time of disease evolution was 20.5 yr. for FA, and 14.9 yr. for NF ataxia (p < 0.1). A mixed urinary syndrome was predominant in 53% of the patients, and 41.1% presented pure irritative symptoms in relation to voiding urgency (85.2%). The most frequent urodynamic diagnosis was detrusor hyperreflexia (61.7%) (37.5% with dyssynergia), followed by areflexia (or hyporeflexia) (23.5%), and normal studies (14.7%). Detrusor hyperreflexia presented with irritative urinary symptoms in 85.7% of the patients, and areflexia or hyporeflexia presented with obstructive symptoms in 75% of the cases. CONCLUSION: Although there is a good clinical-urodynamic correlation in cases of ataxia, we consider it is necessary to perform a complete urodynamic study in males with hereditary ataxia in order to rule out bladder outlet obstruction due to BPH. On the other hand, due to the fact that progression of the lesions can modify the clinical picture of the patient (including urinary tract symptoms), we consider essential to re-evaluate ataxic patients periodically to adapt their treatment to the urodynamic diagnosis.

Correlación clínico-urodinámica en las ataxias hereditarias / Clinical-Urodynamic correlation in hereditary ataxias

OBJETIVOS: Evaluar los síntomas funcionales del tracto urinario inferior en una serie de sujetos atáxicos y caracterizar mediante estudio urodinámico el tipo de disfunción neurógena vésico-uretral en cada caso. Nos planteamos si en las AH sería suficiente con la clínica para establecer el diagnóstico y manejo terapéutico de estos pacientes, o por el contrario sería necesario recurrir a estudio urodinámico en todos los casos. MÉTODOS: Debido a la baja prevalencia de las ataxias hereditarias (AH), y a la situación de movilidad de los pacientes, fue necesario reclutar pacientes de distintos centros hospitalarios. Para el estudio empleamos un protocolo de estudio urodinámico que incluía 1) Evaluación de síntomas urinarios; 2) Exploración física neurourológica; 3) Flujometría con medición de residuo postmiccional; 4) Cistomanometría y 5) Electromiografía perineal. Analizamos la relación entre síntomas urinarios y diagnóstico urodinámico, considerando variables como la edad, sexo, tipo de ataxia y tiempo de evolución de la enfermedad. RESULTADOS: La serie está constituida por 34 pacientes atáxicos con síntomas urinarios, 14 casos ataxia de Friedreich (AF) (41,2 por ciento) y los otros 20 casos pertenecían a diversas formas de ataxia que denominamos no Friedreich (NF) (58,8 por ciento). Edad media global 37,2 años en la AF y 50 años en las NF (p < 0,05). Tiempo medio de evolución de la enfermedad 20,5 años para las AF y de 14,9 años para las ataxias NF (p < 0,1). Predominó el síndrome urinario mixto en el 53 por ciento de los pacientes, presentando síntomas irritativos puros el 41,1 por ciento de los casos, a expensas de urgencia miccional (85,2 por ciento). El diagnóstico urodinámico más frecuente fue hiperreflexia del detrusor (61,7 por ciento) (con disinergia en el 37,5 por ciento), seguido de arreflexia (o hiporreflexia) (23,5 por ciento), y estudios normales (14,7 por ciento). La hiperreflexia del detrusor se manifestó con síntomas urinarios irritativos en 85,7 por ciento de los pacientes, y la arreflexia o hiporreflexia con síntomas obstructivos en 75 por ciento de los casos. CONCLUSIONES: Aunque existe una buena correlación clínico-urodinámica en las ataxias, consideramos necesario realizar estudio urodinámico completo en varones con AH en orden a realizar diagnóstico diferencial con la obstrucción prostática. Por otra parte, debido a que la progresión de las lesiones puede modificar las manifestaciones clínicas del paciente (incluyendo los síntomas urinarios), consideramos esencial la reevaluación periódica de los pacientes atáxicos para adecuar el tratamiento al diagnóstico urodinámico (AU)