Bladder blood flow and de-obstructive open prostatectomy: correlation with clinical and urodynamic parameters.

PURPOSE: To assess the relation between tissue blood flow changes during surgery with clinical and urodynamic parameters in obstructed patients. MATERIAL AND METHODS: A prospective study was conducted in 18 symptomatic patients with bladder outlet obstruction undergoing retropubic prostatectomy. A symptom assessment and a preoperative urodynamic study were performed. To measure bladder blood flow a BLF-10 laser Doppler flowmeter and a blunt-tipped probe were used intraoperatively. Tissue flow was measured in TPU units (1 TPU unit=1 ml per minute per 100 mg of tissue). Six measurements were taken: two control in the rectus abdominis muscle and four in the detrusor, two before the incision of the prostatic capsule and two after closure. For the statistical analysis, Wilcoxon test and a regression analysis were performed. RESULTS: Mean age was 70 years (range: 56-84). Six patients had an episode of acute urinary retention (AUR). No differences were found in the initial and final values of bladder blood flow of the rectus muscle and the bladder dome. A decrease of bladder blood flow in the anterior bladder wall was observed after prostate enucleation. AUR patients showed no differences in bladder blood flow values. Bladder blood flow (BBF) changes showed no correlation with any urodynamic or clinical parameter. CONCLUSIONS: Laser Doppler flowmetry is useful to study BBF with low morbidity, ease of use and reproducibility. Following de-obstructive surgery, a decrease in BBF occurs, probably associated with surgery. These changes are similar in patients with and without AUR and show no correlation with other parameters studied.

[Changes in frequency of external office visits for diseases. Analysis of trends in 6 years]. / Cambios en la frecuentación de patologías en consulta externa. Análisis de la evolución en 6 años.

INTRODUCTION: In 1996 we made a rate frequency analysis of attended pathologies in extern office. Along these years, we have made different actuations about some pathologies like HBP and vasectomy. OBJECTIVES: To know the results of these measures after 6 years, in 2002. MATERIAL AND METHODS: Different pathologies frequency is analyzed in extern office of Urology in 2002 and the results are compared with those we got before making the remake of the action about the mentioned cases. RESULTS: The remake in the treatment of the vasectomy and HBP let us to have a 15% and 1.2% more of first visits in extern office respectively. While the first visits because of suspicion of prostatic cancer has been increased in 25%. Visits because of pathologies like hematuria, renal colic, cystitis and impotency have been increased importantly (56.4%, 51.9%, 61.1% and 17.8%). CONCLUSIONS: The remake of actions on pathologies is a efficacious tool in the management of an Urology Area. Its analysis let us to value the benefits we have got and to detect new problems that appear.

Cambios en la frecuentación de patologías en consulta externa. Análisis de la evolución en 6 años / Frequency changes of attended pathologies in extern office. Evolution analysis in six years

INTRODUCCIÓN: En 1996 realizamos un análisis de la tasa de frecuentación de patologías atendidas en la consulta externa. A lo largo de estos años hemos realizado diversas estrategias de actuación sobre algunas patologías o entidades como la HBP y la contracepción masculina. OBJETIVOS: Conocer el resultado de dichas medidas pasados 6 años, en el año 2002. MATERIAL Y MÉTODO: Se analiza el porcentaje de las distintas patologías vistas en consulta externa de la Unidad de Urología en el año 2002, y se comparan los resultados con los obtenidos antes de haber realizado el rediseño de la actuación sobre los casos mencionados. RESULTADOS: El rediseño en el manejo de la contracepción masculina y de la HBP ha permitido disponer de un 15 por ciento y un 1,2 por ciento más de primeras visitas en consulta externa respectivamente, mientras que se ha incrementado un 25 por ciento la consulta por sospecha de cáncer prostático. Se aprecian importantes incrementos de consultas por patologías como la hematuria (56,4 por ciento), crisis renoureteral (51,9 por ciento), síndrome miccional (61,1 por ciento) e impotencia (17,8 por ciento). CONCLUSIONES: El rediseño de la actuación sobre patologías es una herramienta eficaz en la gestión de una Unidad de Urología. Su análisis permite valorar los beneficios conseguidos y detectar nuevos problemas que surgen (AU)

[Analysis of the delay in surgical treatment of adenocarcinoma of the prostate]. / Análisis de la demora en el tratamiento quirúrgico del adenocarcinoma de próstata.

INTRODUCTION: The prostate cancer is an important cause of men's mortality in our society. PURPOSE: To know the time of delay in to realise the surgical treatment of the prostate cancer. MATERIALS AND METHODS: Analysis of 30 cases of patients treated with radical prostatectomy, cuantifying the time of delay in all the periods of the process. RESULTS: Appointment in general practitioner-first appointment in urology: 21.7 days. First appointment in urology-biopsy: 22.8. Biopsy-diagnosis: 34.3. Diagnosis-appointment of anesthesiology: 28.5. Anesthesiology-radical prostatectomy: 25.7. CONCLUSIONS: There are actions for to reduce the delay in to perform the diagnosis or treatment, where we can act how an improvement plan: to give poblational education in general and information to the patient in particular, to analyze the rules of medical action, to improve the coordination between level, to improve the flexibility in outpatients appointment and time waiting for diagnosis test and treatment, to correct the temporality, to create clinical units of many specialties and to improve the politics of health.

Análisis de la demora en el tratamiento quirúrgico del adenocarcinoma de próstata / Time of delay analysis of surgical treatment of the prostate cancer

INTRODUCCIÓN: El cáncer de próstata es una causa importante de mortalidad masculina en nuestro medio. OBJETIVOS: Conocer el tiempo de demora existente en realizar el tratamiento quirúrgico del adenocarcinoma de próstata. MATERIAL Y MÉTODO: Análisis de 30 casos de pacientes tratados mediante prostatectomía radical, cuantificando los diversos tiempos de demora existentes en las distintas fases del proceso. RESULTADOS: Visita en atención primaria-primera visita en especializada: 21,7 días. Primera visita en especializada-realización de biopsia: 22,8 días. Biopsia-información de diagnóstico: 34,3 días. Diagnósticovisita preanestésica: 28,5 días. Preanestesia-intervención quirúrgica: 25,7 días. COMENTARIOS: Como puntos de importancia en una posible demora diagnóstica-terapéutica, donde podemos actuar como plan de mejora destacamos: la educación poblacional en general y la información al paciente en particular, análisis de las pautas de actuación médica, mejora de la coordinación interniveles, aumento de la flexibilidad en consultas y listas de espera diagnósticas y terapéuticas, corrección de la temporalidad, creación de unidades clínicas multidisciplinarias, y mejora en las políticas sanitarias (AU)

[Giant orthotopic ureterocele. Diagnosis by ureteral jet detection with doppler color ultrasonography]. / Ureterocele gigante ortotópico. Diagnóstico por detección del jet ureteral mediante ecografía doppler color.

OBJECTIVE: To present an additional case of orthotopic ureterocele in a patient that consulted for hematuria and outlet obstruction, with special reference to the utility of non-invasive color doppler ultrasound in the diagnosis of this condition. METHODS/RESULTS: This condition was suspected on detecting a ureteral jet inside a cystic lesion of the bladder. The diagnosis was confirmed by IVP and cytoscopy. Treatment was by transurethral resection with good functional results. CONCLUSION: Color doppler ultrasound is useful for the diagnosis of ureteroceles, particularly in patients in whom contrast or ionizing radiation must be avoided.

Ultrasound-guided needle aspiration in prostatic abscess.

OBJECTIVES: To review the clinical presentation of prostatic abscess and to assess the usefulness of ultrasound-guided needle aspiration as a treatment option for this condition. METHODS: Between October 1984 and November 1997, prostatic abscess was diagnosed in 31 patients. The average age was 60 years (range 29 to 79). Prostate ultrasound was performed using either a hypogastric or transrectal approach. Initial therapy included ultrasound-guided needle aspiration in 24 (77.4%), transurethral resection of prostate (TURP) in 5 (16.1%), or conservative management with antibiotic therapy. During follow-up, ultrasound examinations and urine cultures were performed on an outpatient basis. RESULTS: Past medical history most often included previous urinary infection (15 patients, 48%) and bladder outlet obstruction (13 patients, 42%). Sixty-one percent of patients presented with irritative voiding symptoms at the time of diagnosis. Ultrasound-guided needle aspiration resolved 83.3% of cases; 2 patients needed a second procedure. Three patients required TURP for drainage and 2 to remove an obstruction after abscess resolution. CONCLUSIONS: A high degree of suspicion is needed to diagnose prostatic abscess clinically. Transrectal ultrasound is necessary for the differential diagnosis. Transrectal ultrasound-guided needle aspiration is a technically simple and effective therapeutic procedure with no morbidity and, in case of failure, may be repeated or a drainage TURP may be undertaken.

[Lithiasis in megacalyosis]. / La litiasis en la megacaliosis.

OBJECTIVE: To review our series of lithiasis associated with megacalyosis, a rare disease entity. METHODS/RESULTS: The clinical records of patients treated from 1976 to 1994 were reviewed. Of 39 cases of megacalyosis, 27 were associated with lithiasis and was slightly more prevalent in males (59.3%). Struvite and whewelite calculi were more prevalent and 40.7% also had urinary tract infection, E. coli, Pseudomonas and Proteus being the most frequent pathogens. ESWL with hyperhydration was the most frequently utilized treatment. CONCLUSIONS: Megacalyosis is an embryogenic anomaly of Malpighi's pyramids that is associated with lithiasis in 69.2% of our series, frequently localized to the left side. We have found no significant difference according to sex or a hereditary component. IVP is the principal diagnostic method for megacalyosis. The frequent association of urinary tract infection should be taken into account when instituting treatment.

Incidentally detected renal angiomyolipoma with tumour thrombus into the inferior vena cava.

A right-renal angiomyolipoma with tumour thrombus into the inferior vena cava was incidentally detected. This is the ninth published case of its type and the second incidental case. Presence of a thrombus does not imply invasive disease, but the tumour then is often bigger than 6 cm and radical surgery is mandatory.

Obstrucción de la unión pieloureteral en niños y adolescentes: estudio y tratamiento / Obstruction of the pyelouretheral junction in children and adolescents: study and treatment

Se presenta un estudio retrospectivo de 84 pacienes que en el período comprendido entre enero del 86 y agosto del 95 fueron sometidos a una ureteropieloplastía. La Orografía intravenosa realizada a los 6 meses de la intervención mostró ausencia de dilatación en 20 riñones 56 con ectasia residual (95 por ciento de exito). Anulación en un caso y persistencia de la obtrucción en 3 casos. 9 pacientes no acudieron al control. Se presentaron complicaciones en 8 pacientes (8,9 por ciento). Dado el carácter histórico de nuestra serie tenemos una baja incidencia de diagnóstico prenatal de obtrucción de la UPU. 21 por ciento, que en las series actuales se acerca al 70 por ciento gracias al uso sístemático de la ecografía durante el embarazo. El diagnóstico prenatal nos pemitiría llevar a cabo la reparación de la obtrucción de la UPU lo más precozmente posible. Ya que parece existir un menor índice de complicaciones.con un mayor índice de éxitos en los grupos de menor edad

[Lithiasis in renal transplantation]. / Litiasis en trasplante renal.

Lithiasis as a post-renal transplantation complication is rare and of delayed appearance. After having revised 320 transplantations performed at the Fundación Puigvert 8 cases were found, which implies a two-fold increased incidence over other series studied and greater than the prevalence in the normal population. We confirmed the existence of lithogenous factors in 7 of the 8 cases, and found that in 50% of them the calculus composition was urate, what explained the differences versus normal population in terms of treatment with cyclosporin and the personal background. Two therapeutic schemes may be outlined based on the chemical composition of the calculus, and thus ultrasound-guided ESWL is chosen as chronic therapy when calculi have a calcic origin whereas medical management is used when their nature is uric, even though we understand that treatment must be individualized in each case. We have obtained good results in all 8 cases without compromising neither the renal function nor the graft viability.