Outpatient simultaneous treatment of benign prostatic hyperplasia and bladder lithiasis with GreenLight™ and holmium laser.

PURPOSE: To evaluate our experience in the combined treatment of benign prostatic hyperplasia (BPH) and bladder lithiasis with GreenLight(™) and holmium laser, respectively, on an outpatient basis. PATIENTS AND METHODS: From August 2006 to May 2009, 20 patients with prostatic hyperplasia and bladder lithiasis were treated. First, the lithiasis was treated, and then the GreenLight laser vaporization of the prostate was performed, both at the same surgical time and under general anesthesia. Discharge of patients was scheduled 3 to 4 hours after completion of the procedure. RESULTS: The procedure was simultaneously completed in 19 of 20 patients. The mean stone size was 2.3 (1-4) cm, and the mean prostate volume was 56.5 (30-108) cc. The mean operating time was 115 (50-190) minutes. There was a significant percentage change in maximum flow, postmicturition residual volume, and International Prostate Symptom Score, which were 129.5%, 88.4%, and 68.3%, respectively. All patients were stone free after the procedure. CONCLUSIONS: The combined transurethral treatment of BPH associated with bladder lithiasis by means of GreenLight laser vaporization and holmium laser lithotripsy on an outpatient basis can be performed safely and yields excellent results.

Severe sleep apnea and risk of ischemic stroke in the elderly.

BACKGROUND AND PURPOSE: Convincing evidence of a causal relationship between sleep apnea and stroke has been shown recently in several prospective, well-designed studies. However, these studies have focused on middle-aged people, excluding the elderly population from analysis. To investigate whether sleep apnea represents an independent risk factor in this population, we performed a prospective longitudinal study in a population-based cohort of subjects from 70 to 100 years old. METHODS: Within the context of the Vitoria Sleep Project, a population-based study designed to investigate the prevalence of sleep apnea in the population of Vitoria, Spain, we performed a 6-year longitudinal study in a subsample cohort of 394 noninstitutionalized, initially event-free subjects (70 to 100 years old, median 77.28 years, 57.1% males). Demographic and polysomnographic data and known confounding factors (age, sex, smoking and alcohol consumption status, body mass index, systolic and diastolic blood pressure, total serum cholesterol levels, and the presence or absence of diabetes mellitus, atrial fibrillation, and hypertension) were assessed at baseline. Hazard ratio for developing an ischemic stroke in relation to the apnea-hypopnea index at baseline was calculated. RESULTS: Over the 6-year follow-up period, 20 ischemic strokes were registered. After adjustment for confounding factors, subjects with severe obstructive sleep apnea hypopnea (defined as apnea-hypopnea index >or=30) at baseline had an increased risk of developing a stroke (hazard ratio=2.52, 95% CI=1.04 to 6.01, P=0.04). CONCLUSIONS: This study shows that severe obstructive sleep apnea hypopnea (defined as apnea-hypopnea index >or=30) increases the risk of ischemic stroke in the elderly population, independent of known confounding factors.

[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.