Procedimientos quirúrgicos urológicos mayores en el cáncer colorrectal localmente avanzado / Major Urologic Surgical Procedures in Locally Advanced Colorectal Cancers

Objetivo: Evaluar los resultados de los principales procedimientos urológicos realizados en pacientes con cáncer colorrectal localmente avanzado. Material y métodos: Los datos de 37 pacientes con cáncer colorrectal localmente avanzado, que se sometieron a los principales procedimientos quirúrgicos urológicos junto con la cirugía simultánea del cáncer entre los años 2005 y 2010, fueron evaluados retrospectivamente. Resultados: La media de edad fue de 58,3 años. La proporción hombre/mujer fue de 2,7. El 59% de los pacientes eran casos primarios y el 41% eran casos recurrentes de cáncer colorrectal. La vejiga, los uréteres, la uretra, los riñones y la próstata se encontraron invadidos en 19, 9, 5, 2 y 2 casos, respectivamente. Se llevaron a cabo los siguientes procedimientos simples o combinados; cistectomía parcial (n=11) o total (n=8; 2 en combinación con uretrocutaneostomía, 6 con conducto ileal), uretroplastia (n=5), nefroureterectomía (n=2), nefrectomía radical (n=1), nefrectomía parcial (n=1), ureteroneocistostomía (n=7), colgajo de Boari (n=4), transureteroureterostomía (n=3). El drenaje prolongado fue la complicación quirúrgica más común (27%). Se encontraron fístula uretrocutánea e incontinencia urinaria total en cada una en un paciente, respectivamente. La incidencia de hidronefrosis y la elevación de la creatinina fueron del 38% (27% preoperatoria; 11% posoperatoria) y del 24% (11% preoperatoria; 13% posoperatoria), respectivamente. Dos muertes ocurrieron en el primer mes de operaciones. La duración media del seguimiento fue de 18 (6-28) meses para los 13 pacientes que sobrevivieron. La supervivencia global de 24 casos con resultado de muerte fue de 21 (1-42) meses. Conclusiones: Dado que los efectos finales más importantes de cáncer colorrectal localmente avanzado se encuentran en los riñones desde el punto de vista urológico, el objetivo de un urólogo, como miembro del equipo quirúrgico, debe ser preservar la función renal además de ayudar a la eliminación completa del tumor (AU)

Objective: To evaluate the outcomes of major urological procedures performed in patients with locally advanced colorectal cancer. Material and methods: Data of 37 patients with locally advanced colorectal cancer who underwent major urological surgical procedures along with simultaneous cancer surgery between the years of 2005 and 2010 were retrospectively evaluated. Results: The mean age was 58.3 years. Male/Female ratio was 2.7. 59% of the patients were primary, and 41% were recurrent cases of colorectal cancer. Bladder, ureters, urethra, kidneys and prostate were found as invaded in 19, 9, 5, 2 and 2 cases, respectively. The following single or combined procedures were performed; partial (n=11) or total (n=8; 2 combined with urethrocutaneostomy, 6 with ileal-conduit) cystectomy, urethroplasty (n=5), nephroureterectomy (n=2), radical nephrectomy (n=1), partial nephrectomy (n=1), ureteroneocystostomy (n=7), Boari's flap (n=4), transureteroureterostomy (n=3). Prolonged drainage was the most common surgical complication (27%). Urethrocutaneous fistula and total urinary incontinence were encountered in 1 and 1 patient, respectively. The incidence of hydronephrosis and elevated creatinine were 38% (preoperative 27%; postoperative 11%) and 24% (11% preoperative; 13% postoperative), respectively. Two deaths occurred in the first month of operations. Mean duration of follow up was 18(6-28) months for surviving 13 patients. Overall survival in 24 cases resulting in death was 21(1-42) months. Conclusions: Since the most important eventual effects of locally advanced colorectal cancer are on the kidneys from the urological point of view; the aim of an urologist, as a member of surgical team, should be preserving renal function in addition to helping complete removal of the tumor (AU)

Tratamiento de la fístula urogenital en la mujer / Tretament of Urogenital Fistula in Women

Introducción y objetivo: Nos hemos propuesto evaluar los resultados de los casos de fístula genitourinaria intervenidos en nuestro centro en un período de 10 años. Material y métodos: Hemos evaluado la información clínica que respecta a la fístula genitourinaria a partir del historial médico de 42 pacientes femeninas, que se sometieron a cirugía por esta afección entre mayo de 2001 y junio de 2010. La edad, el historial médico, las herramientas de diagnóstico utilizadas, la información quirúrgica y los resultados clínicos de las pacientes fueron evaluados retrospectivamente. Resultados: La media de edad de las pacientes fue de 51 años. De 42 pacientes 28 tenían fístula vesicovaginal, 11 ureterovaginal y tres vesicouterina. La etiología de la fístula vesicovaginal era traumatismo quirúrgico en el 71,5% y traumatismo obstétrico en el 28,5% de las pacientes. La técnica de O’Connor se llevó a cabo como único procedimiento en 12 casos de fístula vesicovaginal, añadiendo la ureteroneocistostomía en tres. La reparación transvesical se llevó a cabo en 9 y la reparación transvaginal en tres de las pacientes. Los 11 casos de fístula ureterovaginal eran de origen yatrogénico. La ureteroneocistostomía se llevó a cabo en 6 de estas pacientes y el flap de Boari en 5. Fundamentalmente se repararon tres fístulas vesicouterinas. El índice de éxito en las fístulas vesicovaginal, ureterovaginal y vesicouterinas fue del 96, 100 y 100% respectivamente. Conclusión: En manos expertas, y de acuerdo con los principios básicos de cirugía, el tratamiento quirúrgico en la fístula genitourinaria representa una modalidad efectiva con un alto índice de éxito (AU)

Introduction and objectives: We aimed to assess the results of the genitourinary fistula cases intervened in our center in a ten year period. Patients and methods: We evaluated the clinical data regarding genitourinary fistula from the medical records of 42 female patients who underwent surgery for this condition between May 2001 and June 2010. Age, previous medical history, diagnostic tools used, operative data and clinical outcomes of the patients were evaluated retrospectively. Results: The mean age of patients was 51 years. Of 42 patients, 28 had vesicovaginal, 11 had ureterovaginal, and 3 had vesicouterine fistulas. Etiology of vesicovaginal fistula was surgical trauma in 71,5% and obstetric trauma in 28,5% of the patients. O’Connor technique was performed as a single procedure in 12 vesicovaginal fistula cases, and ureteroneocystostomy was added in 3. Transvesical repair was performed in 9, and transvaginal repair in 3 of the patients. All of 11 patients with ureterovaginal fistula were of iatrogenic origin; ureteroneocystostomy was performed in 6, and Boari flap was performed in 5 of these patients. Three vesicouterine fistulas were repaired primarily. Success rates in vesicovaginal, ureterovaginal and vesicouterine fistulas were 96, 100 and 100 percent, respectively. Conclusion: In experienced hands and according with the related basic surgical principles, operative treatment in genitourinary fistula represents an effective modality with high success rate (AU)

[Major urologic surgical procedures in locally advanced colorectal cancers]. / Procedimientos quirúrgicos urológicos mayores en el cáncer colorrectal localmente avanzado.

OBJECTIVE: To evaluate the outcomes of major urological procedures performed in patients with locally advanced colorectal cancer. MATERIAL AND METHODS: Data of 37 patients with locally advanced colorectal cancer who underwent major urological surgical procedures along with simultaneous cancer surgery between the years of 2005 and 2010 were retrospectively evaluated. RESULTS: The mean age was 58.3 years. Male/Female ratio was 2.7. 59% of the patients were primary, and 41% were recurrent cases of colorectal cancer. Bladder, ureters, urethra, kidneys and prostate were found as invaded in 19, 9, 5, 2 and 2 cases, respectively. The following single or combined procedures were performed; partial (n=11) or total (n=8; 2 combined with urethrocutaneostomy, 6 with ileal-conduit) cystectomy, urethroplasty (n=5), nephroureterectomy (n=2), radical nephrectomy (n=1), partial nephrectomy (n=1), ureteroneocystostomy (n=7), Boari's flap (n=4), transureteroureterostomy (n=3). Prolonged drainage was the most common surgical complication (27%). Urethrocutaneous fistula and total urinary incontinence were encountered in 1 and 1 patient, respectively. The incidence of hydronephrosis and elevated creatinine were 38% (preoperative 27%; postoperative 11%) and 24% (11% preoperative; 13% postoperative), respectively. Two deaths occurred in the first month of operations. Mean duration of follow up was 18(6-28) months for surviving 13 patients. Overall survival in 24 cases resulting in death was 21(1-42) months. CONCLUSIONS: Since the most important eventual effects of locally advanced colorectal cancer are on the kidneys from the urological point of view; the aim of an urologist, as a member of surgical team, should be preserving renal function in addition to helping complete removal of the tumor.

[Treatment of urogenital fistula in women]. / Tratamiento de la fístula urogenital en la mujer.

INTRODUCTION AND OBJECTIVES: We aimed to assess the results of the genitourinary fistula cases intervened in our center in a ten year period. PATIENTS AND METHODS: We evaluated the clinical data regarding genitourinary fistula from the medical records of 42 female patients who underwent surgery for this condition between May 2001 and June 2010. Age, previous medical history, diagnostic tools used, operative data and clinical outcomes of the patients were evaluated retrospectively. RESULTS: The mean age of patients was 51 years. Of 42 patients, 28 had vesicovaginal, 11 had ureterovaginal, and 3 had vesicouterine fistulas. Etiology of vesicovaginal fistula was surgical trauma in 71,5% and obstetric trauma in 28,5% of the patients. O'Connor technique was performed as a single procedure in 12 vesicovaginal fistula cases, and ureteroneocystostomy was added in 3. Transvesical repair was performed in 9, and transvaginal repair in 3 of the patients. All of 11 patients with ureterovaginal fistula were of iatrogenic origin; ureteroneocystostomy was performed in 6, and Boari flap was performed in 5 of these patients. Three vesicouterine fistulas were repaired primarily. Success rates in vesicovaginal, ureterovaginal and vesicouterine fistulas were 96, 100 and 100 percent, respectively. CONCLUSION: In experienced hands and according with the related basic surgical principles, operative treatment in genitourinary fistula represents an effective modality with high success rate.

Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study.

End-stage renal disease (ESRD) affects sexual function. The etiology of sexual dysfunction in ESRD is multifactorial and hypogonadism is not uncommon. In a cohort of 96 men with ESRD, scores on International Index of Erectile Function (IIEF) correlated with bioavailable testosterone (T; P<0.01). We further evaluated the effects of administration of T on ED in hypogonadal men on hemodialysis. Nine men with ED and hypogonadism (baseline bioavailable T <3.82 nmol l(-1)), received 5 g T-gel (1% (10 mg g(-1)) per day treatment for 6 months. The IIEF and frequency of sexual intercourse per week were used to assess treatment efficacy. T administration significantly increased serum T levels to the normal range, and was associated with statistically significant improvements of the scores of the IIEF domains (erectile function from 7.6+/-8.0 to 12.8+/-7.8; intercourse satisfaction from 3.4+/-4.5 to 4.8+/-3.1; orgasmic function from 4.8+/-3.1 to 3.4+/-2.9; sexual desire from 3.4+/-2.9 to 4.4+/-0.6; overall sexual satisfaction from 2.6+/-1.3 to 3.8+/-1.0). But scores of the IIEF did not normalize. Frequency of weekly sexual intercourse increased from 0.4+/-0.4 to 1.1+/-0.8 (P<0.05) after 6 months. There were no adverse effects. We conclude that restoring T levels to normal in men with ESRD improved scores on the IIEF and frequency of weekly sexual intercourse.