Prevalence and risk factors for gallstone disease.

Gallstone disease is a main public health problem. The overall prevalence data range from 3.9% in the pre-echographic era to 13.7% when ultrasonography was used as a diagnostic tool. This study is aimed to determine the prevalence of gallstone disease in a medium income level population in Lima, as well as the relationship with some risk factors: age, sex, familiar history and obesity. A total of 534 adult men and women from a medium economic level underwent ultrasonographic examination of abdomen for detection of gallstone disease (July 2003). The echographic evaluation was performed by 10 general surgeons trained in ultrasonography. Likewise, 4 risk factors--age, gender, familial history, and obesity--were analyzed. Pearson chi2 test (2-sided) was used with a probability of <0.05 for statistical significance and logistic regression analyses for assessment of confounding factors. The prevalence founded was 15%. Eighty-one of 534 participants had lithiasis. Compared to the age group under 30, the odds ratio for the 31 to 50 years and >50 years of age group was 0.9 and 1.1, respectively. The female-male ratio was 1.07 and the odds ratio 0.8. The prevalence of gallstone disease in people reporting a first-degree relative with lithiasis was 21%, whereas in participants without such a condition, it was 13%. On the other hand, a familial history was present in 38% of the lithiasis group and in 25% of the nonlithiasis group. The odds ratio for familial history was 1.8 (P = 0.01, 95% confidence interval 1.1-2.9). The prevalence of the disease for body mass index <24, 25 to 29, and higher than 30 was 17%, 14% and 13%, respectively. Compared to the reference group (body mass index <24), the other 2 groups (body mass index 25-29 and >30) both had a similar odds ratio, 0.8. Logistic regression analyses showed an odds ratio of 1.9 for familiar history (95% confidence interval 1.1-3.2), whereas the odds ratio of the overweight (body mass index 25-29) and obese group (body mass index >30) when compared to the normal group, BMI <24, was 0.7 and 0.9, respectively. The prevalence data for gallstone disease remain slightly higher than those previously reported. Although the familiar history was the only characteristic with a statistically significant positive relationship with lithiasis, additional studies are needed because few biases could not be completely avoided and some confounding factors were not controlled.

[Occlusive urethral systems: can they constitute an alternative in the management of female stress incontinence?]. / Sistemas oclusivos uretrales: pueden constituir una alternativa en el manejo de la incontinencia urinaria femenina de esfuerzo?

OBJECTIVE: To determine the utility of the urethral plug in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted in 20 female patients with stress urinary incontinence in order to evaluate the efficacy of a new urethral plug. The mean age was 59.6 +/- 6.2 years (range 40-66). The study design included 3 visits (4 weeks). The results were considered "positive" when urinary incontinence decreased and the patient referred a subjective sensation of improvement, and "negative" if otherwise. RESULTS: Positive results were demonstrated in 8 patients (40%). Ten patients (50%) refused to continue, mainly due to urinary tract infection in 7 cases (35%), difficulties in plug use (loss of plugs, anomalous urethral anatomy, cystocele,...) in 6 cases (30%) and urethral mucosa irritation in one case (5%). No plug migrated into the bladder. The initial urinary incontinence grade in the positive cases were: minor in 4 (50%), mild in 2 (25%) and severe in 2 (25%). We found no statistical relationship between the urinary incontinence grade and clinical results. The patients used a median of 5 plugs per day. Of the 10 patients who completed the study, 5 (50%) refused to continue using the plug and 5 (50%) decided to continue using the plug in combination with electrostimulation and/or pelvic floor exercises. CONCLUSIONS: The use of the urethral plug in the management of female stress urinary incontinence is not an alternative to surgical treatment or pelvic floor rehabilitation. However, it could be useful for patients who are unwilling or unfit for surgery. Finally, the urethral plug is an alternative to the use of collecting systems or devices in female stress urinary incontinence.

[Upper urinary tract and urethral tumors in patients with bladder carcinoma]. / Tumores de tracto urinario superior y uretra en pacientes con carcinoma de vejiga.

OBJECTIVE: A clinicopathological study was conducted in patients with urothelial tumor of the bladder and urothelial neoplasm of the upper urinary tract or urethra to analyze the histological features, time interval between diagnoses and prognosis of these associated lesions. METHODS: 338 patients were reviewed retrospectively. A descriptive study was performed, including tables on the associated lesions and survival data. RESULTS: 21 cases (6.2%) had two urothelial tumors: carcinoma of the bladder associated with tumor of the upper urinary tract (14 cases) or urethra (7 cases). There is a longer time interval between diagnoses when the extravesical tumor is diagnosed after than when it is diagnosed before the bladder tumor (p < .05). A correlation between the grade, but not stage, of the extravescial and bladder tumors has been observed. We found no statistically significant differences for survival in patients with two tumors or with bladder cancer alone. Although not statistically significant, patients with metachronous extravescial tumor have a better prognosis than those with synchronous extravesical tumor. CONCLUSION: Patients with bladder cancer should be followed for years and screened for extravesical urothelial tumor. The foregoing associated lesion, especially the metachronous extravesical lesion, apparently does not make the prognosis worse.

Renal echinococcosis: clinical study of 34 cases.

PURPOSE: Hydatid disease, a cyclo-zoonotic parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is prevalent worldwide. We reviewed the clinical findings of a large series of renal hydatidosis treated in an endemic area with special emphasis on diagnostic pitfalls. MATERIALS AND METHODS: A retrospective 15-year review in a rural area of central Spain (600,000 population), with a global incidence of hydatidosis of 10 new cases per 100,000 population per year, revealed 34 with renal echinococcosis treated surgically (3 to 4% of officially confirmed cases of hydatidosis). Clinical, radiological and laboratory data were analyzed. RESULTS: Renal hydatid disease mimicked other diseases. The combination of clinical history, imaging studies, and serological and urine investigation yielded a reliable pretreatment diagnosis in only 50% of cases and a presumptive diagnosis in 71%. Among imaging studies computerized tomography was the most valuable diagnostic examination. Moderate eosinophilia was found in half of the cases, while a third had scoleces in the urine. A diagnostic and therapeutic algorithm is presented. CONCLUSIONS: Preoperative diagnosis of renal hydatid disease is difficult even in an endemic zone. Imaging studies are suggestive but usually inconclusive, and the differential diagnosis with a renal tumor or complicated cyst may not be made without surgery. Renal sparing surgery is possible in a significant proportion of cases, particularly when preoperative diagnosis has been considered. Significant surgical morbidity can be expected, and the risk of anaphylaxis and hydatid seeding, although low, should not be overlooked.

[Prospective study of the effectiveness and side effects of intracavernous prostaglandin E1 versus papaverine or papaverine phentolamine in the diagnosis and treatment of erection dysfunction. Review of the literature]. / Estudio prospectivo de eficacia y efectos secundarios de la prostaglandina E1 versus papaverina o papaverina fentolamina intracavernosa en el diagnóstico y tratamiento de la disfunción eréctil. Revisión de la literatura.

E1 prostaglandins (E1-PG) by intracavernous injection has been given for diagnostic purposes to 70 randomly selected patients visiting the practice with erectile dysfunction (ED). Sixty-one were suggested to begin a weekly intracavernous self-injection (WICSI) according to the established protocol. Fifty-one patients (83.6%) started the therapy and within an 18-months follow-up interval only 2 (3.27%) preferred to return to papaverine, since 20 patients had previously undergone the papaverine test and 6 were on WICSI with this preparation. Fifty-three patients (75%) achieved complete erection, 8 (11.4%) enough erection to penetrate without manual help, representing a total efficacy of 87%. E1-PG dosage varied from 10 to 40 mcg based on diagnosis, and was readjusted in 6 of the 9 patients which in the initial tests had not obtained sufficient erection, therefore bringing about a final 91.4% erections of sufficient characteristics for intercourse to be considered normal. During the year and a half follow-up a total of 2,880 E1-PG self-injections were injected without during this time cases of priapism, systemic reactions, cavernous bodies infections, arteriovenous fistulae, fibrosis of the cavernous bodies, etc, being observed. Two patients showed prolonged erections of 3-5 hours during the E1-PG tests which remitted spontaneously without sequelae and now continue the WICSI programme after dosage readjustment. In our experience, E1-PG intracavernous injection has proven to be more effective than papaverine in the treatment of erectile dysfunction and therefore, added to its safety and degree of acceptance, we consider it a first choice approach in the diagnosis and treatment of erectile dysfunction in males.

[Vesicovaginal fistulas: correction using lyophilized dura mater]. / Fístulas vesicovaginales: corrección con duramadre liofilizada.

Thirty three cases of surgically corrected vesicovaginal fistulae, from a total of 73 patients with iatrogenic or pathological urinary tract conditions examined and treated in our service, are presented in this paper. Both the etiology and different surgical techniques that can be used are reviewed, contributing the novelty use of freeze dried dura mater as the material to interpose for the correction of the fistulae by means of abdominal surgical techniques. The material was used in 6 patients, with recovery being obtained in all cases and achieving the fistulae closure with a single surgical procedure.

[Penile self-injection of a papaverine-phentolamine combination, as treatment of impotence, in patients treated with radical cystoprostatectomy]. / Autoinyección peneana de papaverina fentolamina, como tratamiento de la impotencia, en pacientes sometidos a cistoprostatectomía radical.

Four patients with impotence secondary to radical cystoprostatectomy due to infiltrant vesical urothelial carcinoma, received treatment with a mixture of papaverine-phentolanin, at dosages of 18-0, 34 mg respectively. Good results were obtained in every occasion, all four cases achieving rigid erection for over an hour which allowed penetration. Currently, patients continue peneal self-injection treatment with these drugs, with no complications or therapy failure being reported.

[Purulent urethritis secondary to intraurethral foreign body]. / Uretritis purulenta secundaria a cuerpo extraño intrauretral.

Due to the rarity of the cases presented in this paper, the prolonged time of residence in the urethra and the limited functional repercussion produced by the foreign bodies lodged in the urethra, we consider convenient the exposition of the mentioned cases.