[Combined risk factors leading to well-leg compartment syndrome after laparoscopic radical prostatectomy]. / Factores de riesgo combinados para síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica.

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.

Factores de riesgo combinados para síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica / Combined risk factors leading to well-leg compartment syndrome after laparoscopic radical prostatectomy

El síndrome compartimental de la pierna es una complicación rara después de la prostatectomía radical laparoscópica. Varios factores de riesgo circunstanciales combinados entre sí pueden predisponer al síndrome compartimental, entre ellos la obesidad, criterios de enfermedad vascular periférica (edad avanzada, hipertensión, hiperlipemia y diabetes mellitus), la profilaxis de la tromboembolia venosa con compresión mecánica junto con compresión neumática intermitente, la anestesia general-espinal combinada, un tiempo operatorio prolongado en posición de Trendelenburg y la hipotensión sistémica por sangrado intraoperatorio. Se expone el caso de un varón de 68 años de edad que sufrió síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica por cáncer de próstata, se trata de la patogenia de esta complicación grave y se destacan las medidas preventivas (AU)

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted (AU)

Reasons why patients reject digital rectal examination when screening for prostate cancer.

OBJECTIVE: To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer. METHODS: Four hundred and fifty men were prospectively evaluated in a prostate cancer educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables. RESULTS: DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28. 1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0. 121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019). CONCLUSIONS: The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time.

Reasons why patients reject digital rectal examination when screening for prostate cancer / Razones por las que los pacientes rechazan el tacto rectal cuando se someten a cribaje de cáncer de próstata

Objective: To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer. Methods: Four hundred and fifty men were prospectively evaluated in a prostate cancer educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables. Results: DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28.1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0.121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019). Conclusions: The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time (AU)

Objetivo: Evaluar las razones por las que los pacientes rechazan el tacto rectal cuando se someten a cribaje de cáncer de próstata. Métodos: 450 hombres fueron evaluados respectivamente en un programa de educación sobre cáncer de próstata consistente en conferencias, evaluación del PSA y tacto rectal. Se compararon los pacientes que rechazaron el tacto rectal con los que aceptaron hacérselo considerando las variables epidemiológicas, sociales y culturales. Resultados: El 8,2% de los pacientes rechazaron el tacto rectal. La tasa de rechazos no mostró diferencias cuando se estratifica los pacientes por edad, historia familiar de cáncer de próstata, nivel de escolarización, ingresos familiares y nivel del PSA. Los pacientes con historia previa de tacto rectal presentaron una tasa de rechazo menor que aquellos sometidos a tacto rectal por primera vez (4,4% vs. I0,4%,p = 0,038). Los pacientes asintomáticos o con síntomas del tracto urinario inferior leves rechazaron el tacto rectal con mayor frecuencia que los que tenían síntomas moderados o severos (9,6% vs. 1,4%, p = 0,018). El 84% de los que rechazaron el tacto rectal tenían un concepto erróneo sobre el cribaje cáncer de próstata frente al 46,9% de los controles (p = 0,002); en 43,7% del grupo que rechazaron el tacto rectal esperaban una molestia severa frente al 28,1% del grupo control (p = 0,090); el miedo a que le fuera detectado cáncer durante el tacto rectal está presente del 34,4% de los pacientes que rechazaron el tacto rectal frente al 46,9% de los controles (p = 0,121); y el 53,1% de los pacientes que rechazaron el tacto rectal respondieron que este era una motivo de vergüenza, frente al 15,6% de los pacientes del grupo control (p = 0,019). Conclusiones: Las principales razones por las que los pacientes rechazan el tacto rectal cuando se someten a cribaje de cáncer de próstata son la falta de síntomas del tracto urinario inferior, conceptos erróneos sobre el cribaje de cáncer de próstata y la vergüenza, especialmente cuando se someten a cribaje por primera vez (AU)