Repercusión de las lesiones medulares traumáticas en la dinámica vesical: perspectivas de seguimiento / Repercussão das lesões medulares traumáticas na dinâmica vesical: perspectivas de seguimento / Repercussion of medullary lesions on the bladder dynamics: follow-up perspectives

Las lesiones en la médula espinal representan un porcentaje importante como causa de discapacidad en México y en el mundo, siendo la tercera causa con un porcentaje superior a 25%. Este tipo de pacientes sufre múltiples complicaciones y una de ellas es la que corresponde al sistema urológico al que muchas veces no se le da un seguimiento de manera regular. Dentro de las lesiones de las vías neurológicas, que inervan a la vejiga, pueden afectar a uno o varios aspectos de la fisiología, ya sea su fase de llenado, de almacenamiento o de vaciamiento, lo anterior según el área nerviosa alcanzada y la naturaleza de la lesión; estas lesiones deben ser manejadas por el mismo urólogo que debe seleccionar la opción terapéutica adecuada en su ámbito de competencia, tomando en cuenta los pros y contras de cada una de ellas, ya que esto tendrá una repercusión en la calidad de vida del paciente, así como continuar un programa de seguimiento para la detección de complicaciones de manera oportuna. Particularmente el cateterismo urinario es pilar fundamental para el manejo de las lesiones medulares postraumáticas, ya que puede contribuir a la disminución de las complicaciones.

As lesões da medula espinhal representam um percentual significativo das causas de deficiência no México e no mundo, sendo a terceira causa, com um percentual acima de 25%. Estes pacientes sofrem de múltiplas complicações, e uma delas é do sistema urológico, ao qual muitas vezes não é dado seguimento adequado. Entre as lesões das vias neurológicas que enervam a bexiga, pode ser afetados um ou mais aspectos da fisiologia, seja na fase de o armazenamento, esvaziamento ou enchimento, dependendo da área do nervo afectado e da natureza da lesão, tais lesões devem ser tratadas pelo urologista, que deve selecionar a opção terapêutica apropriada em sua área de competência, levando em conta os prós e contras de cada um, pois isso impacta a qualidade de vida dos pacientes, bem como continuar um programa de monitoramento para a detecção de complicações em tempo hábil. A cateterização urinária é, particularmente, um pilar fundamental para a gestão da lesão traumática da medula espinal, uma vez que pode contribuir para a redução de complicações.

Spinal cord injuries represent a significant percentage of causes of disability in Mexico and worldwide, being the third largest cause, with a percentage of more than 25%. These patients suffer from multiple complications, one of which relates to the urological system, which often does not receive appropriate follow-up. Among the lesions of the neurological pathways that innervate the bladder, one or more aspects of its physiology may be affected, whether in the filling, storage or voiding phases, depending on the nerve area affected and the nature of the injury. These lesions should be handled by the urologist, who should select the most suitable therapeutic option within his or her area of competence and taking into account the advantages and disadvantages of each option, as this will have an impact on the quality of life of the patient, as well as continuing a monitoring program for timely detection of complications. Urinary catheterization is, in particular, a fundamental pillar for the management of traumatic lesion of the spinal cord, as it can help reduce complications.

A dramatic case of genital radionecrosis.

BACKGROUND: Epidermoid carcinoma of the penis presents in 1% of malignant tumors in men. Penis cancer treatment has traditionally been total or partial amputation. There are authors who consider radiation to be part of penis cancer treatment in select cases--especially the use of brachytherapy and external radiation. CLINICAL CASE: The case of a 48-year-old male who in 2004 presented with an ulcerated lesion of the penis that was left unattended to is presented. Two years later, he sought medical attention and physical examination revealed an ulcerated penile lesion with poorly defined edges and limited to the glans. DIAGNOSIS: The lesion was biopsied and the histopathological study reported Epidermoid Carcinoma. After radiological studies, it was classified as stage T2-N0-M0. TREATMENT: Total penectomy without lymphadenectomy was performed. The patient received adjuvant treatment of 15 sessions of cobalt radiation treatment at a dose of 3,500 cGy. Six months later, the patient noticed the presence of erythema at the genital and inguinal level which later ulcerated and extended toward the perineum. The disease progressed tragically and the patient died 2 years later.

Angiotensin-converting enzyme insertion/deletion and angiotensin type 1 receptor A1166C polymorphisms as genetic risk factors in benign prostatic hyperplasia and prostate cancer.

INTRODUCTION: Prostate cancer is one of the most common malignant neoplasias in developed countries. In 2003, 6,536 new cases and 4,602 related deaths were reported in Mexico. The renin-angiotensin system has been shown to play a role in prostate cancer pathology. Two previous studies investigated the association of prostate cancer with the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene; both studies reported an association between prostate cancer and the DD genotype. The present study was aimed at searching for an association of prostate cancer and benign prostatic hyperplasia with the I/D polymorphism in the ACE gene and the A1166C polymorphism in the angiotensin type 1 receptor (AGT1R) gene and at comparing allele frequencies between both groups and the general population. MATERIALS AND METHODS: DNA was extracted from 20 samples from individuals with a prostate cancer diagnosis and from 20 samples from individuals with a benign prostatic hyperplasia diagnosis. Genotyping was performed by PCR-RFLP analysis. Polymorphism frequency results obtained for the test groups were compared with the frequencies in 66 individuals from the general population, which were previously obtained at the same molecular medicine laboratory in the context of other studies. RESULTS: The comparative analysis of the three groups revealed significant differences for allele frequencies in the two genes in patients groups (prostate cancer and benign prostatic hyperplasia) versus the general population. The D allele in the ACE gene was closely associated with a significant higher risk of developing both benign prostatic hyperplasia (odds ratio [OR]=21.87; 95% confidence interval [CI]=2.314-206.479) or prostate cancer (OR=31.66; 95% CI=0.091-1.272), and the AGT1R A1166 allele in the homozygote state was identified as a risk genotype for benign prostatic hyperplasia (OR=56.07). CONCLUSIONS: Genotypes in ACE and AGT1R polymorphisms could be considered as genetic risk markers for benign prostatic hyperplasia or prostate cancer.

[Subarachnoid blockade with ropivacaine versus bupivacaine in urologic and orthopedic surgery]. / Bloqueo raquídeo subaracnoideo con ropivacaína versus bupivacaína isobárica en cirugía urológica y ortopédica.

OBJECTIVE: To compare the effects of intrathecal isobaric ropivacaine (IR) versus isobaric bupivacaine (IB) in a dose ratio of 3:2 in non-ambulatory urologic and orthopedic surgery. METHODS: One hundred and seventeen patients scheduled for surgery were randomized and assigned in a double-blind fashion to receive either 15 mg of IR (n = 58) or 10 mg of IB (n = 59) into the subarachnoid space. RESULTS: There were no differences about age, sex distribution, body mass index, type of surgical interventions and operative time. Both groups were similar respect to latency time and extension of sensory block. Complete motor blockade was reached in more than 90 % of patients of both groups ten minutes after the intrathecal injection and the length was significantly longer in the IB group (226.4 +/- 22.3 minutes versus 266.5 +/- 29.5, p < 0.001). There was no significant hypotension or bradicardia during the transoperative period. Three and a half hours after the end of the surgery, more patients of the IB group required intravenous analgesics and opiaceous derivates (p < 0.001). CONCLUSIONS: The motor blockade was longer in the IB group but postoperative analgesia was better in the IR group.