Risk factors of Peyronie's disease. What does our clinical experience show?

INTRODUCTION: Peyronie's disease (PD) is a localized fibrosis that affects the tunica albuginea of the penis. Its origin can be associated with coital penile trauma in men with autoimmune hypersensitivity and a presumed genetic predisposition. AIM: To identify clinical and traumatic risk factors in a patient population with PD, when compared to a control group. METHODS: From November 2007 to March 2010, 317 patients sought medical attention for PD. As control group, 147 consecutive patients, who came for a prostate exam, were studied. Clinical, traumatic, and sexual history of these patients was gathered. Risks factors were considered only if they had been present before the onset of PD symptoms. MAIN OUTCOME MEASURE: The International Index of Erectile Function and the International Prostate Symptoms Score. A univariate logistic regression model (chi-square) (odds ratios [ORs] and 95% confidence intervals [CI]) was used to estimate the association of risk factors with PD; and the Student's t-test was implemented for age. RESULTS: The mean age of patients with PD and control group was 56.7 and 58.8, respectively (P<0.923). The mean evolution time of the disease was 17.7 months (2-48). Erectile dysfunction (ED) and coital trauma constituted the only two independent risk factors for PD compared to the control group (P<0.05 and 0.002, respectively) with an OR of 1.5 (95% CI 1.0-2.3) and 2.69 (95% CI 1.41-5.21), respectively. Patients with ED and diabetes mellitus and with a mild-to-moderate ED also presented a higher predisposition (P=0.008 and 0.00001), with an OR of 3.64 (95% CI 1.33-10.79) and 5.58 (95% CI 3.03-10.42), respectively. CONCLUSION: Erectile dysfunction and coital trauma have proven to be independent risk factors for the development of PD.

Glanuloplasty with urethral flap after partial penectomy.

PURPOSE: We describe a surgical technique to reconstruct the glans secondary to partial penectomy or traumatic partial amputation as well as its complications. We assessed urethral flap vitality and the tumor recurrence rate using this technique. MATERIALS AND METHODS: Glanuloplasty with a urethral flap was done in 10 patients who underwent partial penectomy for penile squamous cell carcinoma. We reconstructed the neoglans with a urethral flap at the same surgical resection. Mean patient age was 61 years (range 18 to 71). Mean followup was 11 months (range 5 to 17). RESULTS: We noted no neomeatal stenosis or flap necrosis secondary to the technique. The early tumor recurrence rate was 10% and the penile curvature rate was 10%. Penile curvature was ventral with no associated penetration difficulty. CONCLUSIONS: This simple, reproducible technique has satisfactory functional and cosmetic results, and an acceptable complication rate for this type of pathological condition.

Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study.

INTRODUCTION: The high incidence of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in aging men and the same pathophysiology make probable to treat both disorders with the same treatment. Numerous authors evaluated the actions of PDE5i in improving the LUTS/(benign prostate hyperplasia) BPH. AIM: To assess the efficacy and safety of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day in patients with LUTS in a crossover design study. MAIN OUTCOMES MEASURES: International Prostate Symptoms Score (IPSS), IPSS Quality of Life (IPSS-QOL), maximum flow rate (Qmax), post-void residual volume (PVR), International Index of Erectile Function-Erectile Function Domain (IIEF-EF), Global Assessment Quality (GAQ). For the statistical analysis, a Tukey-Kramer multicomparison test was used. METHODS: A randomized, double-blind, crossover study was conducted from September 2007 to February 2008 in one center. Thirty men, older than 50 years old, with a history of LUTS/BPH of at least 6 months, were randomized into two groups to receive tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day for 45 days, and then switched to the other treatment mode for other 45 days. RESULTS: Twenty-seven patients completed the study. Improvements of IPSS score and IPSS-QOL were significant with both treatments but greater with the drug combination. Both regimens similarly improved the Qmax and decreased the PVR volume from baseline (P < 0.001) with no significant differences between tamsulosin alone vs. tamsulosin and tadalafil (P > 0.05). The IIEF improved with tamsulosin plus tadalafil (P < 0.001) but not with tamsulosin alone (P > 0.05). The GAQ showed that all patients preferred the combination scheme. Both treatments were well tolerated. CONCLUSION; Tamsulosin 0.4 mg/day plus tadalafil 20 mg/day was more effective than tamsulosin 0.4 mg/day alone to improve LUTS and erectile dysfunction and was also well tolerated. Large-scale, randomized, placebo-controlled studies are needed to further assess the long-term safety and effectiveness of these agents in treating LUTS/BPH with or without ED.

[Percutaneous renal surgery with minimal access: miniperc]. / Cirugía renal percutánea con acceso mínimo: miniperc.

OBJECTIVES: To describe the technique of the minimal access percutaneous nephrolithectomy, miniperc, and to analyze the results obtained with this treatment in adult patients. METHODS: We performed 42 minipercs between august 2002 and December 2003. Mean patient age was 48 years (19-62). The procedure was undertaken using a 14Fr Amplatz sheath. Stone size varied from 1.5-3.5 cm in longest diameter (1.5-7 cm2). Lithofragmentation was performed by pneumatic lithotripsy. RESULTS: Average procedure time was 75.2 min. (range from 60 to 120). All patients were discharged within 24 hours. Only three patients (7.1%) have a hematocrit descent over 2 points. No nephrostomy tube was left for the postoperative time. 95.2% of the patients were stone free 1 month after surgery. CONCLUSIONS: Our results make us consider the minimal access percutaneous nephrolithectomy (Miniperc) a minimal option for the elimination of renal stones, with low morbidity, diminishment of the hospital stays, very low analgesic demand, and no transfusion requirements.

Cirugía renal percutánea con acceso mínimo: miniperc / Pecutaneous renal surgery with minimal access: miniperc

OBJETIVO: Describir los detalles técnicos de la nefrolitotomía percutánea con mínimo acceso, Miniperc, y analizar los resultados obtenidos con este procedimiento en pacientes adultos. MÉTODOS: Hemos realizado 42 mini-perc en un periodo comprendido entre Agosto del 2002 y Diciembre del 2003. La edad promedio de los pacientes fue de 48 años, (19 - 62). El procedimiento se llevó a cabo empleando un amplatz de 14 Fr. El tamaño dela litiasis vario entre 1.5 - 3.5 cm en su diámetro mayor (1.5 - 7 cm2). La litofragmentación se realizó mediante litotricia neumática. RESULTADOS: La duración promedio del procedimiento fue de 75.2 minutos (rango entre 60 y 120). Todos los pacientes fueron dados de alta a las 24 hs. Solo tres pacientes (7.1%) tuvieron un descenso del hematocrito en 2 puntos. No se dejó nefrostomía en el postoperatorio. El 95,2 % de los pacientes quedaron libres delitiasis al mes de la cirugía. CONCLUSIÓN: Los resultados obtenidos en nuestra serie nos permiten considerar a la nefrolitotricia percutánea con mínimo acceso (Miniperc) como una nueva alternativa para la remoción de la litiasis renal, con una muy baja morbilidad, disminución del índice de hospitalización, escasa demanda analgésica y sin requerimiento tranfusional

OBJECTIVES: To describe the technique of the minimal access percutaneous nephrolithectomy, miniperc, and to analyze the results obtained with this treatment in adult patients. METHODS: We performed 42 minipercs between august 2002 and December 2003. Mean patient age was 48 years (19-62). The procedure was undertakenusing a 14Fr Amplatz sheath. Stone size varied from1.5-3.5 cm in longest diameter (1.5-7 cm2 ). Lithofragmentation was performed by pneumaticlithotripsy.RESULTS: Average procedure time was 75.2 min. (range from 60 to 120). All patients were dischargedwithin 24 hours. Only three patients (7.1%) have ahematocrit descent over 2 points. No nephrostomy tubewas left for the postoperative time. 95.2% of the patients were stone free 1 month after surgery. CONCLUSIONS: Our results make us consider the minimal access percutaneous nephrolithectomy (Miniperc) a minimal option for the elimination of renal stones, with low morbidity, diminishment of the hospital stays, very low analgesic demand, and no transfusion requirements

Fibrosis retroperitoneal / Retroperitoneal fibrosis

Se presenta un caso de fibrosis retroperitoneal, analizándose su etiopatogenia, cuadro clínico, métodos de diagnóstico, diagnóstico diferencial y tratamiento, señalándose la evolución favorable de este paciente con la terapéutica quirúrgica realizada (AU)

Fibrosis retroperitoneal / Retroperitoneal fibrosis

Se presenta un caso de fibrosis retroperitoneal, analizándose su etiopatogenia, cuadro clínico, métodos de diagnóstico, diagnóstico diferencial y tratamiento, señalándose la evolución favorable de este paciente con la terapéutica quirúrgica realizada