[Follow-up of the FlowSecure artificial urinary sphincter]. / Seguimiento del esfínter urinario artificial FlowSecure.

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.

[Antibiotic prophylaxis in transrectal prostate biopsy]. / Profilaxis antibiótica en la biopsia transrectal de próstata.

INTRODUCTION: Transrectal ultrasound-guided needle biopsy of the prostate is a safe technique, but it is not complication-free, and its most serious complications are genitourinary infections (GUI) and the conditions they cause. The purpose of antibiotic prophylaxis is to reduce this GUI incidence rate. However, no established guidelines exist and there are significant differences among centres where this procedure is performed. The objective of the present report is to review antibiotic prophylaxis protocols described in the literature. MATERIAL AND METHODS: We reviewed indexed articles published in English or Spanish and accessible through literature databases. RESULTS: Five articles comparing antibiotic prophylaxis with a placebo observe lower bacteriuria and infectious complications percentage rates in the group receiving prophylaxis. In most cases, E. coli is the microorganism responsible for infection. Oral quinolones are the most commonly prescribed prophylactic antibiotics. Three studies of oral vs. parenteral prophylaxis found no differences between the two groups. Three other articles comparing short term and single-dose prophylaxis found no differences between the two groups. CONCLUSIONS: Administering prophylactic antibiotics is more advantageous than not doing so. The moment for beginning prophylaxis depends on the antibiotic's bioavailability and how it is administered. The chosen antibiotic will preferably be administered orally as a single dose or short term course, according to the sensitivities of prevalent microorganisms. More studies are needed to determine what role pre-biopsy enemas play in reducing infectious complications.

Seguimiento del esfínter urinario artificial FlowSecure / Follow-up of the FlowSecure artificial urinary sphincter

El esfínter urinario artificial AMS-800 ha sido la única prótesis disponible para el tratamiento de la incontinencia urinaria de esfuerzo refractaria a otras modalidades terapéuticas durante los últimos 25 años. La tasa relativamente elevada de complicaciones derivadas de su utilización durante este tiempo provocó una serie de modificaciones en su diseño, lo que dio como resultado la aparición en el mercado del esfínter urinario artificial Flow Secure. El esfínter urinario artificial Flow Secure es una prótesis ajustable rellena de suero salino sin contraste, por lo que la radiografía simple no es útil para su seguimiento; la ecografía es la técnica radiológica más adecuada para su valoración. Además de calcular el residuo posmiccional, la ecografía permite verificar el estado de la prótesis y calcular la presión a la que está siendo sometida la uretra por el esfínter. Al uso de la ecografía debe de añadirse la utilización de flujometría y de una historia clínica detallada. Estos últimos son los elementos adecuados para realizar una valoración funcional correcta del paciente portador de la prótesis, ya que permiten valorar la necesidad de ajustar la presión del sistema a la continencia del paciente, si esto fuera necesario (AU)

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the Flow Secure artificial sphincter. The Flow Secure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the Flow Secure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence (AU)

Profilaxis antibiótica en la biopsia transrectal de próstata / Antibiotic prophylaxis in transrectal prostate biopsy

Introducción: La biopsia transrectal de próstata ecodirigida es una técnica segura pero no exenta de complicaciones; las más graves son las infecciones urinarias y sus consecuencias. La profilaxis antibiótica pretende reducir esas complicaciones; sin embargo, no existe un protocolo establecido y hay notables diferencias entre los centros que llevan a cabo esta técnica. El objetivo del presente trabajo consiste en revisar diferentes aspectos de los protocolos de profilaxis antibiótica recogidos en la literatura científica. Material y métodos: Se revisaron artículos indexados, publicados en inglés o español, recogidos en bases bibliográficas. Resultados: En 5 trabajos que compararon la profilaxis con el placebo el porcentaje de bacteriuria y complicaciones infecciosas fue menor en los grupos con profilaxis. El microorganismo causante en la mayoría de los casos fue Escherichia coli. Los antibióticos más empleados son las quinolonas por vía oral. En 3 trabajos que emplearon profilaxis oral o parenteral no hubo diferencias entre ambos grupos. Otros 3 artículos que compararon la pauta corta y la monodosis no observaron mayor beneficio con la pauta corta. Conclusiones: Administrar profilaxis es más ventajoso que no hacerlo. El momento para iniciar la profilaxis dependerá de la biodisponibilidad del fármaco y de la vía elegida. El antibiótico empleado preferiblemente se administrará por vía oral, en monodosis o pauta corta, teniendo en cuenta las sensibilidades de los microorganismos prevalentes. Son necesarios más estudios para determinar el papel de los enemas en la reducción de las complicaciones infecciosas (AU)

Introduction: Transrectal ultrasound-guided needle biopsy of the prostate is a safe technique, but it is not complication-free, and its most serious complications are genitourinary infections (GUI) and the conditions they cause. The purpose of antibiotic prophylaxis is to reduce this GUI incidence rate. However, no established guidelines exist and there are significant differences among centres where this procedure is performed. The objective of the present report is to review antibiotic prophylaxis protocols described in the literature. Material and methods: We reviewed indexed articles published in English or Spanish and accessible through literature databases. Results: Five articles comparing antibiotic prophylaxis with a placebo observe lower bacteriuria and infectious complications percentage rates in the group receiving prophylaxis. In most cases, E. coli is the microorganism responsible for infection. Oral quinolones are the most commonly prescribed prophylactic antibiotics. Three studies of oral vs. parenteral prophylaxis found no differences between the two groups. Three other articles comparing short term and single-dose prophylaxis found no differences between the two groups. Conclusions: Administering prophylactic antibiotics is more advantageous than not doing so. The moment for beginning prophylaxis depends on the antibiotic’s bioavailability and how it is administered. The chosen antibiotic will preferably be administered orally as a single dose or short term course, according to the sensitivities of prevalent microorganisms. More studies are needed to determine what role pre-biopsy enemas play in reducing infectious complications (AU)

Fístula reno-duodenal en el contexto de un tumor renal / Renal-Duodenal fistula in the context of a renal tumor

No disponible

Surgical implantation of the new FlowSecure artificial urinary sphincter in the female bladder neck.

OBJECTIVE: To report implantation of the new FlowSecure artificial urinary sphincter with conditional occlusion in a female bladder neck, describe surgical technique and suggest minor modifications to accommodate the device for universal female implantation. PATIENT AND METHODS: A spina bifida female patient with urodynamically proven stress incontinence due to sphincteric incompetence associated to atonic detrusor was implanted with the new artificial sphincter. Operating time was one and a half hours. The cuff was adjusted to the bladder neck with no problems. Excess belt removed from the cuff was preserved and used for loose fixation of tubing and reservoirs in the right paravesical space. The control pump was placed in the right labia. The prosthesis was implanted at atmospheric pressure zero. RESULTS: The device was easily implanted. There were no perioperative complications. Catheter was removed 24 h post-implantation and patient achieved immediate total continence. There was no need for device pressurization at subsequent follow-up. The patient needed intermittent self-catheterization for emptying her bladder because of impaired detrusor contractility. CONCLUSIONS: Despite that the new FlowSecure artificial urinary sphincter has only been used for bulbar urethral implantation, we have successfully implanted the device in a female bladder neck with excellent clinical results. Cuff lengthening and connecting tubes shortening would probably enable all female patients to be suitable for implantation. To the best of our knowledge, this is the first time the device has been implanted in a bladder neck.

[Papillary and cavitary monohydrate calcium oxalate lithiasis: comparative study of etiological factors]. / Litiasis de oxalato cálcico monohidrato papilar y de cavidad: estudio comparativo de factores etiológicos.

OBJECTIVES: The monohydrate calcium oxalate lithiasis (MCO) is divided in two groups depending on the morphologic-crystal structure: papillary (anchorage point on a renal papilla lesion) and cavity (formed in a cavity with low urodynamic capacity). The minimal differences between urinary biochemistry of MCO makers in comparison with healthy population suggests that other factors different than urine biochemistry (professional activity, dietetic habits, systemic diseases) may be related with lithogenesis. The objective of this work is to study such factors, and compare them in both groups of MCO lithiasis (papillary and cavity). METHODS: We study 40 patients with MCO lithiasis (20 patients papillary and 20 patients cavitary). Medical history was performed (family history of lithiasis; associated diseases such as high blood pressure, diabetes, hyperuricemia, hypercholesterolemia, peptic ulcer disease; dietetic survey to evaluate phytate consumption; professions with high-risk of exposure to toxic agents); 24-hour urine biochemical tests, two-hour urine (pH), and serum biochemical profile were performed. Statistical analysis was performed using student's t test and chi-square. RESULTS: There is a high prevalence of family history of renal lithiasis (45%) without differences between groups. There are not differences in urine or blood biochemical tests. There is a low consumption of phytate-containing foods in both groups, without significant differences. There is a trend to a greater exposure to cytotoxic agents in the papillary group (45%) vs. the cavity group (25%). Hypertension and hyperuricemia are more prevalent in the cavity MCO group (alpha = 0.025 and alpha = 0.010, respectively). Peptic ulcer disease is more prevalent in the papillary MCO group (alpha = 2.025). There are no significant differences in prevalence of hypercholesterolemia or diabetes mellitus between groups. CONCLUSIONS: Papillary MCO calculi are associated with a deficit of crystallization inhibitors (phytates), and disorders of the epithelium covering the renal papilla (cytotoxic agents exposure, peptic ulcer disease). Cavity MCO calculi are associated with a deficit of crystallization inhibitors (phytates) and a greater amount of heterogeneous nucleants (organic material induced by diseases such as hypertension, hyperuricemia, hyperglycemia, and hypercholesterolemia).

Litiasis de oxalato cálcico monohidrato papilar y de cavidad: estudio comparativo de factores etiológicos / Papillary and cavitary monohydrate calcium oxalate lithiasis: comparative study of etiological factors

OBJETIVO: La litiasis de oxalato cálcico monohidrato (COM) se divide en dos grupos según su estructura morfocristalina: papilares (punto de anclaje sobre una lesión en la papila renal), y de cavidad (formadosen una cavidad con baja eficacia urodinámica). Las escasas diferencias entre la bioquímica urinaria de los formadores de COM con respecto a la población sana sugiere que otros factores no relacionados con la bioquímica urinaria (actividad profesional, hábitos dietéticos,enfermedades sistémicas) pueden estar relacionadoscon la calculogénesis. El objetivo de este trabajo es el estudio de estos factores, y su comparación en ambos grupos de COM (papilar y de cavidad).MÉTODOS: Se estudian 40 pacientes con litiasis de COM (20 pacientes con COM papilar y 20 pacientescon COM de cavidad). Se realiza historia clínica (antecedentes familiares de litiasis; enfermedades asociadascomo hipertensión arterial, diabetes mellitus, hiperuricemia, hipercolesterolemia, úlcera gastroduodenal;encuesta de alimentación para valorar consumo de fitatos ; profesiones con riesgo de exposición a agentes tóxicos), bioquímica de orina de 24 horas, orina de 2 horas (pH), bioquímica plasmática. El estudio estadísticose realiza utilizando la t de Student y la X2.RESULTADOS: Existe una elevada prevalencia de antecedentesfamiliares de litiasis renal (45%) sin diferencias entre ambos grupos. No existen diferencias en la bioquímicaurinaria ni plasmática. Existe un bajo consumo de alimentos que contienen fitatos en ambos grupos, sin existir diferencias significativas. Existe una tendencia hacia una mayor exposición a agentes citotóxicos en el grupo papilar (45%) frente a cavidad (25%). La hipertensiónarterial e hiperuricemia son más prevalentes en el COM cavidad (α = 0,025 y α = 0,010; respectivamente).La úlcera gastroduodenal es más prevalente en el COM papilar (α =0,025). No existen diferencias significativas en la prevalencia de hipercolesterolemia y diabetes mellitus entre ambos grupos.CONCLUSIONES: Los cálculos COM papilares se asocianun déficit de inhibidores de la cristalización (fitatos),y a alteraciones del epitelio que recubre la papila renal (exposición a agentes citotóxicos, úlcera gastroduodenal).Los cálculos COM de cavidad se asocian a un déficit de inhibidores de la cristalización (fitatos) y a una mayor presencia de nucleantes heterogéneos (materia orgánica inducida por enfermedades como la hipertensión arterial, hiperuricemia, hiperglucemia e hipercolesterolemia)

OBJECTIVES: The monohydrate calcium oxalate lithiasis (MCO) is divided in two groups depending on the morphologic-crystal structure: papillary (anchorage point on a renal papilla lesion) and cavity (formed in a cavity with low urodynamic capacity). The minimal differences between urinary biochemistry of MCO makers in comparison with healthy population suggests that other factors different than urine biochemistry (professional activity, dietetic habits, systemic diseases) may be related with lithogenesis. The objective of this work is to study such factors, and compare them in both groups of MCO lithiasis (papillary and cavity). METHODS: We study 40 patients with MCO lithiasis (20 patients papillary and 20 patients cavitary). Medical history was performed (family history of lithiasis; associated diseases such as high blood pressure, diabetes, hyperuricemia, hypercholesterolemia, peptic ulcer disease; dietetic survey to evaluate phytate consumption; professions with high-risk of exposure to toxic agents); 24-hour urine biochemical tests, two-hour urine (pH), and serum biochemical profile were performed. Statistical analysis was performed using student’s t test and chi-square. RESULTS: There is a high prevalence of family history of renal lithiasis (45%) without differences between groups. There are not differences in urine or blood biochemical tests. There is a low consumption of phytate-containing foods in both groups, without significant differences. There is a trend to a greater exposure to cytotoxic agents in the papillary group (45%) vs. the cavity group (25%). Hypertension and hyperuricemia are more prevalent in the cavity MCO group (α = 0.025 and α = 0.010, respectively). Peptic ulcer disease is more prevalent in the papillary MCO group (α = 2.025). There are no significant differences in prevalence of hypercholesterolemia or diabetes mellitus between groups. CONCLUSIONS: Papillary MCO calculi are associated with a deficit of crystallization inhibitors (phytates), and disorders of the epithelium covering the renal papilla (cytotoxic agents exposure, peptic ulcer disease). Cavity MCO calculi are associated with a deficit of crystallization inhibitors (phytates) and a greater amount of heterogeneous nucleants (organic material induced by diseases such as hypertension, hyperuricemia, hyperglycemia, and hypercholesterolemia)

Priapismo de bajo flujo asociado a lupus eritematoso sistémico y síndrome nefrótico / Lwo flow priapism associated with systemic lupus erythematosus and nephrotic syndrome

OBJETIVO: Presentar un caso de priapismo asociado a lupus eritematoso sistémico (LES) y síndrome nefrótico. METODO: Paciente de 29 años con pluripatología previa que acudió a Urgencias por presentar un priapismo doloroso de 12 horas de evolución. La sangre intracavernosa resultante del aspirado era sangre oscura, de aspecto venoso. De los factores de riesgo analizados tanto el lupus eritematoso como el síndrome nefrótico son causas conocidas de estados de hipercoagulabilidad que pueden conducir a la aparición de un priapismo de bajo flujo. RESULTADO: No hubo respuesta a la aspiración-lavado, ni a la administración de agonistas alfa-adrenérgicos. El alto riesgo quirúrgico del paciente desaconsejó la intervención quirúrgica. El priaprismo cedió a sexto día, permaneciendo el paciente sin erecciones espontáneas hasta la fecha. CONCLUSION: Tanto el LES como el Síndrome nefrótico pueden ser causas potenciales de priapismo de bajo flujo. El mejor tratamiento es la prevención con profilaxis antitrombótica adecuada (AU)