Can cystinuria decrease the effectiveness of RIRS with high-power ho:yag laser in children? Outcomes from a tertiary endourology referral center.

Cystinuria, which is the cause of cystine urolithiasis, accounts for 2-6% of all urinary stones in children, has a low prevalence with a high recurrence rate, making this metabolic disorder a therapeutic challenge in pediatric population. The aim of this work is evaluate the efficacy and safety of retrograde intra-renal surgery (RIRS) in pediatric patients with cystinuria and kidney stones smaller than 2 cm. Prospective study of 64 stones treated in 22 retrograde intra-renal surgeries (RIRS) in cystinuric pediatric patients with renal or proximal ureteral stones less than 2 cm. Average age of 9.5 years. The following data were analyzed: demographics, stone characteristics and surgical data with intra- and postoperative complications. Location of the stones was 68.7% in the calyces, 20.3% in the renal pelvis, and 9.3% in the ureteropelvic junction; 41% of cases had multiple locations. The average cystinuria level before the procedure was 825 mg/dL. The anatomy of 73% of the interventions increased the difficulty of flexible ureteroscopy and decreased stone free rates, because distorted renal anatomy was present: sclerosis of the pelvis or infundibulum, abnormal calyceal dilations, or excluded calyces. Intraoperative complications occurred in 18.2% of the procedures. Reno-vesical ultrasound was performed in all patients in the first postoperative month, with an SFR of 59%. Cystinuric patients are a challenge for pediatric urologists, decreasing the effectiveness of RIRS. However, it could be better treatment than SWL and with fewer complications than PCNL in the pediatric population with this disease.

Robot-assisted Radical Prostatectomy Due to a Primary Carcinoid Prostatic Tumor in a Three-Year-Old Child: A Case Report.

We present an extremely rare case of a 3-year-old child with a primary carcinoid tumor of the prostate. A 3-year-old boy presented with failure to thrive, constipation, recurrent respiratory tract infections, and pain in the genital area. His karyotype was normal and cystic fibrosis and coeliac disease were excluded prior to further investigation. An abdominopelvic computed tomography scan revealed a prostatic mass. Transrectal ultrasound-guided prostate biopsy was therefore performed and pathological examination revealed a carcinoid tumor. A robotic radical prostatectomy was performed. As this is an innovative surgical approach, we describe the surgical technique used.

Estudio de la eficacia y preferencia de los pacientes con disfunción eréctil grave después de tomar los 3 inhibidores de la fosfodiesterasa 5 / Study of the efficacy and preferences among severe erectile dysfunction patients after taking 3 phosphodiesterase 5 inhibitors

Objetivo: Evaluar la eficacia de sildenafilo (100 mg), vardenafilo (20 mg) y tadalafilo (20 mg) en el tratamiento de la disfunción eréctil grave. Evaluar la preferencia de los pacientes después de tomar los 3 fármacos. Material y metodos: Los pacientes tomaron de forma secuencial sildenafilo (100 mg), vardenafilo (20 mg) y tadalafilo (20 mg) al menos 4 veces cada uno durante 30-45 días con un período de lavado entre un fármaco y otro de 7 días. En total, se incluyó a 151 pacientes para obtener una muestra válida de 108 casos (18 por cada grupo de aleatorización, 6 grupos en total). Los pacientes incluidos tenían disfunción eréctil grave. Resultados: Las puntuaciones del índice internacional de función eréctil mejoraron con respecto a las basales, y estas fueron estadísticamente significativas en todos los casos (P < 0,0001). Cuando se compararon las puntuaciones del índice internacional de función eréctil, el Erectile Dysfunction Inventory of Treatment Satisfaction, versión paciente, Erectile Dysfunction Inventory of Treatment Satisfaction, versión pareja y Sexual Encounter Profile (SEP) mediante el test no paramétrico para medidas relacionadas de Friedman, se observaron diferencias estadísticamente significativas en todos ellos menos en SEP-2 y SEP-3. Cuando se compararon entre ellos mediante el test de Wilcoxon, encontramos diferencias estadísticamente significativas en el índice internacional de función eréctil entre tadalafilo y sildenafilo (P < 0,003) y entre tadalafilo y vardenafilo (P < 0,001). También las encontramos en el Erectile Dysfunction Inventory of Treatment Satisfaction, versión pareja entre sildenafilo y vardenafilo (P < 0,013). En todos los otros casos, excepto en el SEP-2 y SEP-3, las diferencias entre tadalafilo y los otros 2 fármacos fue muy cercana a la significancia. No hubo ninguna diferencia entre sildenafilo y vardenafilo. Cuando se evaluó la preferencia por un fármaco u otro, 20 eligieron sildenafilo (18,5%), 19 vardenafilo (17,8%), 43 tadalafilo (39,8%) y 22 no eligieron ninguno por falta de eficacia (24,05%). Conclusiones: Las diferencias estadísticamente significativas observadas cuando se compararon los diferentes cuestionarios utilizados llevan a creer que aparte de la preferencia subjetiva de los pacientes per se, su preferencia se basa también en la respuesta superior a un fármaco en comparación con los otros (AU)

Objective: To evaluate the efficacy of sildenafil (100 mg), vardenafil (20 mg) and tadalafil (20mg) in the treatment of severe erectile dysfunction and to evaluate their preferences after having taken all three drugs. Material and methods: The patients took sildenafil (100 mg), vardenafil (20 mg) and tadalafil (20 mg) sequentially at least four times each over 30-45 days with a wash-out period of 7 days between one drug and the next. In total, 151 patients were included to obtain a valid sample of 108 cases (18 for each randomization group, six groups in total). The included patients had severe erectile dysfunction. Results: The IIEF scores improved compared to baseline values, these improvements being statistically significant in all cases (P<0.0001). When the scores on the IIEF, EDITS patient version, EDITS partner version and SEP using Friedman's non-parametric test for related measures were compared, statistically significant differences were observed in all of them except SEP-2 and SEP-3. When compared with each other using Wilcoxon's test, we found statistically significant differences in the IIEF between tadalafil and sildenafil (P<0.003) and between tadalafil and vardenafil (P<0.001). We also found these in the EDITS partner version between sildenafil and vardenafil (P<0.013). In the other cases except SEP-2 and SEP-3, the differences between tadalafil and the other two drugs were very close to significance. There was no difference between sildenafil and vardenafil. As for their preference for one drug over the others, 20 chose sildenafil (18.5%), 19 vardenafil (17.8%), 43 tadalafil (39.8%) and 22 did not choose any due to lack of efficacy (24.05%). Conclusions: The statistically significant differences observed when comparing the different questionnaires used lead to the belief that, apart from the subjective preference of patients per se, their preference is also based on a greater response to one drug in comparison with the others (AU)