La incontinencia urinaria

Urinary incontinence, understood as any involuntary loss of urine, constitutes an important medical and social problem. It can be classified as stress urinary incontinence, urgent urinary incontinence or mixed urinary incontinence. The proportions of these three types of urinary incontinence are difficult to establish and vary notably between sources, but they might be about 40, 33 and 20% respectively. Its diagnosis requires a correct clinical history and physical exploration, together with some complementary explorations. The first therapeutic step consists of hygienicdietary measures and behaviour modification techniques. Pharmacological treatment is specific for each type of urinary incontinence, using anticholinergics and inhibitors of serotonin reuptake. Finally, different surgical techniques have a role in cases where conservative treatments fail or when dealing with severe urinary incontinence

Trasplante celular y terapia regenerativa con células madre

Uno de los campos de la medicina que más expectativas ha levantado en los últimos años es la terapia celular con células madre. El aislamiento de células embrionarias humanas, la aparente e inesperada potencialidad de las células madre adultas y el desarrollo de la terapia génica nos lleva a imaginar un futuro esperanzador para un importante número de enfermedades actualmente incurables. A lo largo de las siguientes páginas vamos a tratar de dibujar el panorama de la investigación con células madre, describiendo los principales logros en este campo así como algunas de las preguntas pendientes de responder. A pesar de las grandes expectativas, es fundamental que mantengamos un espíritu crítico y realista a la hora de analizar los avances científicos en este área

¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal?

Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events.aterial and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. Results: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8 hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR = 1.04; 95% CI: 0.9-1.08; p > 0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT 18 h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR = 1.1; 95% CI: 1.05-1.15; p < 0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p = 0.02) and less time to the first rejection episode (72.6 days ± 137 vs. 272.2 days ± 614.8; p = 0.023) after 18 hours. The CIT did not seem to be related (p < 0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. Conclusions: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival

Priapismo maligno: un caso manejado de forma conservadora

Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out

Association of crossed renal ectopia and aortic aneurism. Case report

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen

Tratamiento quirúrgico de linfedema peneano secundario a hidrosadenitis supurativa

Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results

Edad del donante y su influencia en la supervivencia del injerto

INTRODUCTION: In 2007 in Spain 43% of donors were older than 60 years. This produces a worse graft quality and probably a worse survival. OBJECTIVE: Our objective is to analyze the influence of donor age on graft survival. MATERIAL AND METHODS: We analyze retrospectively 216 renal consecutive transplants realized between 2000 and 2008. A univaried and multivaried study (Cox regression) was performed and Kaplan-Meyer test with log rank for graft survival. RESULTS: Follow-up mean of 40 months (+/-33,4 SD). The univaried analysis of graft survival showed that donor age had a significative influence on graft survival. (OR=1,03; 95% CI 1,01-1,05) (p: 0,009). Studying the relation between donor and recipient age we find an inverse correlation (Pearson's Correlation: 0,55. p<0,0001), but there are significative differences after the adjustment for recipient age. (OR: 1,02; 95% CI 1,01-1,04) (p: 0,04). Optimal cut-point value determined by the ROC analysis was 60 years. The graft survival of donors over 60 years is 79% (95% CI; 74-84%) and 71% (95% CI; 65-77%) at 3 and 5 years in contrast with 94% (95% CI; 94-96%) and 90% (95% CI; 88-92 in donors under 60. (p: 0,002). The multivaried study of the influential factors on graft survival reveals that donor age dichotomized in older or younger than 60, the presence of a surgical immediate reintervention and a delayed graft function were independent influence factors. CONCLUSIONS: Donor age over 60 years has a negative and independent prognostic influence on graft survival

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graf tsurvival. Results: At least one surgical complication occurred in 82(38%)of the 216 transplantations, and 68(31%)required some type of repeat surgery,23 in the early post operative period and 45 more than 3 months after surgery. Mean follow–up was 48 months(SD þ/ 33.4), and median follow–up 48 months(range,0–166months). No recipient or donor factor spredisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3-and 5-year survival rates of 86%(95%CI83%–89%)and 78%(95%CI73%–82%)as compared to 92% (95%CI90%–94%)and 88%(95%CI85%–91%),p:0.004].Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole groups howed early repeat surgery to bea factor with an independent prognostic value (OR:4.7;95%CI2.2–10,po0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival.Then eed for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival

Impact of renal retransplantation on graft and recipient survival

The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival. METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival. A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests. RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45 (10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (+/-54.1 SD). There were no differences in follow-up between groups (Mean Follow-up 73.1 months +/-54.4 SD in first transplantations vs. 61.6 months +/-51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 89% (95% CI: 87-91%) and 84%(95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI:i; 80-90%) respectively]. After adjusting for all the heterogeneity variables we still did not find differences on graft survival. The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs.97%]. CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one

Factores influyentes en el tiempo hasta la progresión bioquímica después de prostatectomía radical

INTRODUCTION: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. MATERIALS AND METHODS: Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages. RESULTS: With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p=0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p=0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p=0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen ( 10%) (p=0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p=0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p=0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p=0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. CONCLUSION: The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors