[Management of hyposalivation caused by oxybutynin chloride in the treatment of the unstable bladder]. / Manejo de la hiposialia producida por el cloruro de oxibutinina en el tratamiento de la vejiga inestable.

OBJECTIVE: To know the incidence of adverse reactions from Oxybutynin Chloride, with special reference to salivary hyposecretion and to evaluate the effectiveness of the different alternatives employed to solve it. MATERIAL AND METHOD: 144 adult patients with signs and symptoms of voiding urgency and detrusor-hyperactivity incontinence, who were treated with Oxybutynin 5 to 15 mg/day. Hyposecretion of several exocrine glands was evaluated using a questionnaire that included subjective and objective parameters. For managing purposes, patients were divided into 3 groups: 1) General measures; 2) Therapy with sialagogues; and 3) Replacement therapy with artificial saliva. RESULTS: 42% patients treated with Oxybutynin developed mild-to-moderate hyposialism. 26% had severe hyposialism, always related to high dose Oxybutynin. 6% skin dryness, 3% eye dryness and 2% dryness in all the above glands (dry syndrome). Regarding treatment, most patients with mild-to-moderate hyposialism were managed with simple general measures. In severe hyposialism, both sialagogues (Eledoisine) and artificial saliva (Bucalsone) were resolutive in over 90% cases. CONCLUSIONS: Oxybutynin is an effective drug to stop detrusor hyperactivity, but it has a high rate of anticholinergic adverse reactions. There is a number of effective therapeutic options available to alleviate these effects, which allow the patient to continue with the treatment.

[Surgical solutions to iatrogenic ureteral lesions in 31 cases]. / Soluciones quirúrgicas a la yatrogenia ureteral en 31 casos.

OBJECTIVE: To conduct a critical review of the etiological, clinical and diagnostic aspects of iatrogenic ureteral lesions caused by various surgical disciplines, primarily focused on the different therapeutical options used. PATIENTS AND METHOD: Between January 1985 and December 1995, 31 iatrogenic lesions of the ureter, 19 female and 10 male, mean age 52 years, were examined. The right ureter was involved in 19 cases and the left one in 12 (2 bilateral). The ureteral lesion resulted from gynaecological surgery in 19 cases (61%), general surgery in 6 (19%), vascular surgery in 3 (10%) and urology in 3 (10%). In 9 cases (29%) it was diagnosed during surgery: in 14 cases (45%) as a result of clinical signs and symptoms and in 8 cases (25%) casually. Surgery was the option chosen in 22 cases, while in 9 conservative treatment was followed. RESULTS: Surgery solved 91% of damaged ureters, and the best results were seen in patients where lesion was repaired immediately. Conservative treatment was resolutive in all cases. CONCLUSIONS: Gynaecological surgery continues to be the most frequent cause of iatrogenic lesions of the ureter. Ureteral damage in males is now increasing due to the demands from general oncologic surgery, which is usually appreciated by the surgeon which allows immediate repair. Lesions caused by gynaecologic and vascular surgery are commonly overlooked and are diagnosed post-surgically either because of their clinical manifestations or accidentally. The different surgical techniques currently available allow a successful repair of this kind of lesions. Conservative therapy is appropriate in cases that fulfil a series of basic requirements.

[Early diagnosis by opportunistic screening in cancer of the prostate. Results of a 1-year protocol. Comparison with historical data]. / Diagnóstico precoz por cribado oportunístico en cáncer de próstata. Resultados de un año de protocolo. Comparación con datos históricos.

RATIONALE: The high prevalence of Prostate Cancer (PC) and long survival of patients with advanced disease, added to the high cost of palliative treatment (hormone therapy), versus the existence of curative therapies at earlier stages, fully justify the campaigns for early diagnosis. The objective of the study was to increase the number of cases diagnosed at local stages, using an opportunistic screening methodology. METHODS: All male patients between 50-70 years of age, seen over one year in Urology and primary care in CAP-Barceloneta because of urinary symptomatology, were included in a screening program. This cohort were performed total PSA determination and digital rectal examination. When digital rectal examination was suspicious and/or PSA values higher than 4 ng/ml, they underwent echo-guided prostate biopsy. RESULTS: A total of 595 male were seen; 43.9% met the inclusion criteria; 39.4% were rated as suspicious, neoplasia being confirmed in 51% of these. Prevalence of PC in this cohort was 20.1%, half of them in local stage. CONCLUSIONS: Populational screening in PC has proven to be ineffective from a health care standpoint, as opposed to opportunistic screening. Overdiagnosis was not significant, although there were more cases diagnosed in organ-confined stages, this is, eligible for curative therapy; thus, hormone therapy and the resulting morbidity were significantly decreased; quality of life of patients under curative treatment was improved; there was a large reduction of health care costs and, although it will have to be further confirmed in large multicentre series, we believe survival was improved.

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate]. / Análisis de datos epidemiológicos de patología uro-oncológica en un servicio de urología de un Hospital General Universitario. Comentarios respecto al cáncer de próstata.

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.

[Germinal tumor of the testis and acquired immunodeficiency syndrome]. / Tumor germinal de testículo y síndrome de inmunodeficiencia adquirida.

Over the last few years a number of testicular tumours in seropositive patients or patients with AIDS-diagnostic factors have been described in the literature with no clear relationship having been established between both conditions. Most authors believe management should not differ from that being given to non-immunodeficient patients. The paper presents one case of non-seminomatous germinal tumour in a 41-year old homosexual patient, HIV positive, with unfavourable evolution in spite of the treatment received.

[Results of a prospective study of chemoprophylaxis with alternating mitomycin-C and BCG: complete response and recurrence and progression index]. / Resultados de un estudio prospectivo de quimioprofilaxis con Mitomycina-C y BCG alternadas: respuesta completa, índice de recidivas y de progresión.

OBJECTIVES: The high incidence of recurrence in superficial urothelial cancer warrants the use of chemoprophylaxis; however, the results achieved to date have been unsatisfactory. The present study investigated the possibility of reducing the incidence of recurrence of superficial urothelial cancer post-TUR and disease progression. METHODS/RESULTS: 99 patients were treated with monthly instillations of mitomycin-C and BCG alternately for one year, which commenced three weeks following TUR. The incidence of recurrence and progression were 15.3% and 5.10%, respectively. Treatment was well-tolerated and there were minimum side effects. CONCLUSIONS: Chemoprophylaxis with alternating mitomycin-C and BCG therapy in patients with superficial urothelial cancer achieves good results. It is well-tolerated and few side effects were observed.

[Urocolpos: a cause of pseudo-incontinence in aged women]. / Urocolpos: una causa de falsa incontinencia en la mujer senil.

Presentation of our experience in three cases of urocolpos (acquired pudendal lip fusion), a series numerically equivalent to the total number of cases published until now. All patients in our series were older women and presented complete fusion of the small pudendal lips, with only a small pointed puncture in the lower part of the vulva. The main clinical signs and symptoms in our series were: urinary infection in 100%, false incontinence in 66% due to output of urine retained in the vagina, a symptom that has not been described earlier, and acute urine retention in 33%. All patients were successfully treated by means of surgical loosening of the fusioned lips and application of topical estrogens. An analysis is made of clinical and pathoanatomical features which differentiate this entity from the sclerotic and atrophic lichen. Finally, an etiopathogenic hypothesis is raised to explain the fusion acquired by the small pudendal lips in the urocolpos.