Postprostatectomy established stress urinary incontinence treated with duloxetine.

OBJECTIVES: To evaluate the efficacy of duloxetine to treat stress urinary incontinence, 1 of the most frequent complications after radical prostatectomy. Conservative measures and surgery are well-established treatments. However, drug treatment could be an intermediate option. METHODS: All patients had >1 year of follow-up after radical prostatectomy to avoid interfering with the natural recovery period (established stress urinary incontinence). Continence was measured by the average daily use of pads and the International Consultation on Incontinence Questionnaire-short form. In Spain, it is necessary to proceed with off-label use formality, and all patients were informed and agreed. The initial dose of duloxetine was 30 mg once daily and was increased to 60 mg/d. Drug treatment was maintained for 9 months. RESULTS: From June 2006 to July 2007, 68 patients were included. The median age was 68 years (range 52-79). The median duration of duloxetine treatment was 5.56 months (range 1-18). A statistically significant decrease in the International Consultation on Incontinence Questionnaire-Urinary Incontinence-short form (from 13 to 9; P < .001) and the average number of pads/d (from 2 to 1; P < .001) was observed between the initial and 3-month visit. At the end of the follow-up period, 74% and 57% of the patients had a reduced International Consultation on Incontinence Questionnaire-Urinary Incontinence-short form score and a decrease in the number of pads used daily, respectively. Of the 68 patients, 32 (47%) presented with some side effects and 17 patients stopped the treatment because of adverse effects (25%). CONCLUSIONS: Our results suggest that duloxetine is a possible alternative treatment of postprostatectomy established stress urinary incontinence. The continence improvement results were mild and conditioned in part by the frequency of the side effects. Provided that duloxetine does not preclude later continence surgery and the benefits are observed at the first visit, we believe it can be a treatment option for selected patients.

High-intensity focused ultrasound in small renal masses.

High-intensity focused ultrasound (HIFU) competes with radiofrequency and cryotherapy for the treatment of small renal masses as a third option among ablative approaches. As an emerging technique, its possible percutaneous or laparoscopic application, low discomfort to the patient and the absence of complications make this technology attractive for the management of small renal masses. This manuscript will focus on the principles, basic research and clinical applications of HIFU in small renal masses, reviewing the present literature. Therapeutic results are controversial and from an clinical view, HIFU must be considered a technique under investigation at present time. Further research is needed to settle its real indications in the management of small renal masses; maybe technical improvements will certainly facilitate its use in the management of small renal masses in the near future.

Biología molecular en el cáncer de testículo / Molecular biology in testicular cancer

OBJETIVO: En este capítulo se sintetiza y actualiza desde la investigación básica en Biología Molecular el estado actual del conocimiento de la patogenia de los tumores germinales de testículo y el valor de los distintos marcadores genético-moleculares para el manejo de estos tumores MÉTODOS: Revisión de la bibliografía publicada sobre el tema. Se analizan los conocimientos epidemiológicos relacionados con la patogenia de estos tumores, sus cambios citogenéticos y sus cambios a nivel molecular que pudieran servir como factor pronóstico en el protocolo de actuación frente a los mismos CONCLUSIONES: El efecto estrogénico prenatal complementado con el hipergonadotrofismo puberal pueden ser los responsables de la patogenia de los tumores germinales de testículo. Las alteraciones citogenéticas del cromosoma 12, si bien típicas del fenotipo de estos tumores, no parecen servir como factor pronóstico. En cambio, los factores de proliferación celular, preferentemente el Ki-67 ofrecen resultados prometedores como factor pronóstico, pero aún se han de considerar en investigación (AU)