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Lo último en... Current Urology:

  • Avoiding the Obturator Jerk during TURBT
    Introduction: Bladder cancer is the seventh most common cancer in the UK. Transurethral resection of bladder tumor (TURBT) is a relatively common procedure used to treat cancer of the bladder. A serious complication of TURBT is bladder perforation, the risk of which is greatly increased in the presence of an “obturator jerk”. Methods: A literature search was performed on PubMed using the following search criteria “obturator nerve block”, “obturator nerve block in transurethral resection of bladder tumor”, “adductor spasm during transurethral resection of bladder tumor”, “bi-polar diathermy obturator nerve”, and “transvesical obturator nerve block”. Articles describing surgical and anesthetic techniques for reducing adductor spasm during resection of bladder tumors were included. Discussion: TURBT is a relatively common urological operation performed to remove tumors of the bladder. Every measure should be taken to avoid serious complications from both anesthesia and surgery. Surgical measures to reduce the likelihood of an obturator jerk include reducing the diathermy current, avoiding over-distention bladder, and using bipolar diathermy as opposed to monopolar diathermy (although there is conficting evidence for this in the literature). Anesthetists should consider the use of neuromuscular blockade or an obturator nerve block to reduce the incidence of obturator jerk and risk of bladder perforation.
    Curr Urol 2018;12:1-5
  • Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia
    Background: Intravesical prostatic protrusion (IPP) is a manifestation of benign prostatic hyperplasia marked by overgrowth of the prostatic median lobe into the bladder, producing bladder outlet obstruction and related storage and voiding symptoms. Methods: A MEDLINE® database search of the current literature was guided using combination of “prostate” with the following terms: intravesical prostatic protrusion, bladder trabeculation, bladder outlet obstruction, lower urinary tract symptoms, alpha blockers, transrectal ultrasonography, and prostatectomy. Results: Although IPP can be identified via a variety of imaging modalities, it is easily detected via transrectal ultrasonography (TRUS). Failing to detect IPP promptly by TRUS may result in refractory symptoms of benign prostatic hyperplasia, as the condition may not respond to typical α1-adrenoceptor antagonist therapy. In addition, depending on grade, IPP can influence outcomes and complications of prostatectomies. Conclusion: Upon report of lower urinary tract symptoms, initial performance of TRUS along with digital rectal examination prevents delay in the appropriate evaluation and management of prostatic diseases.
    Curr Urol 2018;12:6-12
  • Detecting Novel Urine Biomarkers for the Early Diagnosis of Prostate Cancer: Platelet Derived Growth Factor-BB as a Possible New Target
    Introduction: Although the prostate specific antigen revolutionized the diagnosis of prostate cancer (PCa), it has its limitations. We prospectively examined the potential use of the platelet-derived growth factor-BB (PDGF-BB) as a urine biomarker for the early diagnosis of PCa. Materials and Methods: The urine samples of 118 patients were collected after a prostatic massage and all the patients subsequently underwent ultrasound-guided transrectal biopsy. PDGF-BB was detected in the urine by enzyme-linked immunosorbent assay. Results: Patients with PCa had greater levels of prostate specific antigen and PDGF-BB. Receiver operating characteristic curve analysis showed that the optimal cut-of of PDGF-BB for the prediction of PCa was 1,504.9 with a sensitivity of 60% and a specificity of 51.3%. For a 100 unit increase in PDGF-BB, the likelihood for PCa increased about 4%. Conclusion: PDGF-BB showed a significant predictive ability for PCa. Detection of PDGF-BB in urine with Elisa was easy and improved our diagnostic accuracy in the diagnosis of PCa.
    Curr Urol 2018;12:13-19
  • The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality
    Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials amp; Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.
    Curr Urol 2018;12:20-26
  • Shock Wave Lithotripsy is More Effective for Residual Fragments after Percutaneous Nephrolithotomy than for Primary Stones of the Same Size: A Matched Pair Cohort Study
    Aims: To compare the outcome of shock wave lithotripsy (SWL) on post-percutaneous nephrolithotomy (PCNL) residual fragments (RFs) versus primary stones of the same size through a matched pair study. Methods: Patients with a single 5-15 mm fragment 3 months after PCNL were enrolled (study group n = 59). The control group (n = 67) consisted of all adult patients with a single 5-15 mm renal stone. Results: The success rate of SWL was significantly higher in the study group (81.4 vs. 59.7%; p = 0.008; OR: 2.95). With a cutoff point of Hounsfield units (HU) 750: the success rate was significantly lower in patients with a stone HU ≥ 750 (OR: 3.488). This HU cutoff value had no effect on the outcome of SWL in patients with post-PCNL RF (p = 0.14). On the other hand, the outcome of SWL was significantly more favorable in control group when HU < 750 (p = 0.02). Conclusion: The success rate of SWL was 2.95-fold higher for post-PCNL RFs than in a stone burden-matched control group. The likelihood of stone clearance after SWL was 3.488-fold greater when HU was less than 750. This effect of HU was more prominent in patients receiving SWL for their primary stones while SWL was evenly effective on post PCNL RFs with different HUs.
    Curr Urol 2018;12:27-32
  • Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 3. Urological Electrosurgical Never Events
    Introduction: Surgical fires are unique topics that belong to surgical never events and deserve urological attention. Materials and Methods: A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. Results: Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. Conclusion: Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium.
    Curr Urol 2018;12:33-38
  • The Association between Metabolic Syndrome and High-Stage Primary Urothelial Carcinoma of the Bladder
    Recently, metabolic syndrome (MetS) has become an important public health problem, and its prevalence is increasing. MetS is associated with multifactorial diseases. No reports have suggested a relationship between bladder cancer and high blood pressure, and hyperlipidemia has been reported as a possible risk factor. In the present study, we investigated the relationships between the stage and degree of malignancy of bladder cancer and MetS. Furthermore, we investigated the influence of the components of MetS on the results. We retrospectively analyzed the data of 169 patients who underwent transurethral resection of a bladder tumor in our department between Janurary 2005 and March 2011. MetS was significantly associated with a high histological grade (p < 0.05). MetS and low high-density lipo-protein were found to be significantly associated with the T stage; no other components of MetS were associated with a high stage or grade. Our results demonstrated that a lack of therapy for patients with low high-density lipoprotein levels could be riskier than was previously thought.
    Curr Urol 2018;12:39-42
  • Trans-Arterial Embolization of Renal Cell Carcinoma prior to Percutaneous Ablation: Technical Aspects, Institutional Experience, and Brief Review of the Literature
    This report describes the technical aspects of trans-arterial embolization (TAE) of renal cell carcinoma prior to percutaneous ablation. All patients (n = 11) had a single renal mass (mean tumor diameter = 50.2 mm; range: 28-84 mm). Selective TAE was performed via the common femoral artery. Embolic materials included: particles alone (n = 4), coils alone (n = 1), particles + ethiodized oil (n = 2), particles + coils (n = 1), ethiodized oil + ethanol (n = 2), and particles + ethanol (n = 1). All embolizations were technically successful and no complications have been reported. After embolization, 10 patients underwent cryoablation while 1 patient underwent microwave ablation. Ablations were technically successful in 10 of the 11 patients. Only 3 minor complications were identified but none required treatment. No adverse effect on the patient's glomerular filtration rate was seen from the additional procedure (p = 0.84). TAE of renal cell carcinoma prior to percutaneous ablation is safe and technically-feasible.
    Curr Urol 2018;12:43-49
  • Scrotal Peripheral Primitive Neuroectodermal Tumor
    The peripheral primitive neuroectodermal tumor (pPNET) is a rare malignant tumor originating from neuroectoderm that usually occurs in children or adolescent and is frequently located in the extremities, chest cavity, pelvic cavity and chest wall. We present a rare case of an 84-year-old man with a history of pPNET in the scrotal sac, to our knowledge not previously published in the literature. The presence of a large irreducible mass in the inguinal sac forced to exclude a tumor. Ultrasound and MRI are very useful modalities to assess the location of the mass, its dependency from any organ and the tumoral internal structure. Molecular imaging with the detection of EWS-FLI1 fusion transcripts is useful for the diagnosis and differential diagnosis of Ewing sarcoma/pPNETs.
    Curr Urol 2018;12:50-53
  • Uretero-Arterial Fistula - Not So Rare?
    The first uretero-arterial fistula (UAF) was reported in 1908 by Moschcowitz. In 2009, a systematic review identified 139 cases. Since then a further 23 cases were described with 19 cases originating from a single center. It has been recognized as a very rare condition in the past. However, more recently, the increasing incidence of UAF has led us to believe that this condition is more frequent than previously described. Aging population, improved cancer survival and extensive multimodal pelvic cancer treatments have been recognized as culprits for the increased incidence of UAFs. We have reviewed literature on UAFs, identified risk factors, patho-physiology and treatment options. Also, we present a case of fistulous communication between the internal iliac artery and ureter in a patient with a potential risk factor previously not described in the literature.
    Curr Urol 2018;12:54-56


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