Revista mexicana de urologia最新文献_第6页

Factores asociados a complicaciones en pacientes sometidos a nefrolitotomía percutánea 经皮肾石切开术患者并发症的相关因素

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-05-01 DOI: 10.1016/j.uromx.2016.01.008

J.E. Ceballos-López, R. Carvajal-García, R. Galeana-Ruiz, F. González-González, E.J. Mendoza-Villanueva, J.A. Martínez-Manzo, J.C. Ibarra-Camacho, K. Trujillo-Ríos, L. Villalpando Gómez

Background

Percutaneous nephrolithotomy (PNL) is the standard procedure for kidney stones larger than 2 cm, thus displacing open surgery. The incidence of complications varies from 12.5 to 52.5%, the main ones being fever and bleeding.

Aim

To identify the factors associated with complications in patients that underwent PNL, in accordance with the Clavien-Dindo classification.

Materials and methods

A retrospective, correlational, descriptive, cross-sectional study was conducted. We reviewed 104 patients that underwent PNL within the time frame of 2008 and 2014.

Results

One hundred and four patients were included in the study and there were 38 complications. In accordance with the Clavien-Dindo classification there were grade I (19), grade II (10), grade IIIA (8), and grade IVA (1) complications. The most frequent complication was postoperative bleeding in 11 patients. The complications were related to residual stones (p = 0.032). A grade 2 or higher complication was more likely when the lower calyx was affected (p = 0.027). We found a relation between bleeding and surgery duration > 100 min (p = 0.019).

Conclusions

The Clavien-Dindo classification is a useful tool for standardizing and reporting complications in PNL. Surgery duration > 100 min increased the risk for postoperative bleeding and complications were associated with residual stones.

背景:经皮肾镜取石术(PNL)是治疗大于2厘米肾结石的标准方法，可以取代开放手术。并发症发生率为12.5 ~ 52.5%，以发热、出血为主。目的根据Clavien-Dindo分类，确定与PNL患者并发症相关的因素。材料与方法采用回顾性、相关、描述性、横断面研究。我们回顾了2008年至2014年期间接受PNL的104例患者。结果共纳入104例患者，共发生38例并发症。根据Clavien-Dindo分类，有I级(19)、II级(10)、IIIA级(8)和IVA级(1)并发症。11例患者最常见的并发症是术后出血。并发症与结石残留有关(p = 0.032)。当下肾盏受影响时，2级或更高的并发症更容易发生(p = 0.027)。我们发现出血与手术时间有关>100 min (p = 0.019)。结论Clavien-Dindo分类是规范和报告PNL并发症的有效工具。手术时间>100分钟增加了术后出血和并发症的风险，并伴有残余结石。

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引用次数: 1

Penectomía parcial como tratamiento para el cáncer de pene localizado, Hospital Juárez de México 部分阴茎切除术作为局部阴茎癌的治疗，墨西哥华雷斯医院

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-05-01 DOI: 10.1016/j.uromx.2016.01.009

A.F. Sánchez-Bermeo, G. Martínez-Carrillo, J. Torres-Aguilar, J. Bernal-Hernández

Background

Cancer of the penis presents in individuals between 50 and 70 years of age, representing only 2-5% of the urogenital tumors in men. However, its incidence varies in some Latin American countries (Paraguay, Brazil) and in Puerto Rico, in which it has been reported to reach 10% of the neoplasias affecting men. Surgery for cancer of the penis is mutilating and significantly affects the quality of life of these patients. We describe herein our management of the disease, in accordance with histopathologic stage, proposing less radical management together with oncologic treatment.

Aim

To present our current management of localized cancer of the penis.

Clinical case

A 42-year-old man presented with a suspicious lesion on the penis plus phimosis. The lesion was biopsied and the intraoperative histopathologic study was negative for neoplasia. Lesion excision and circumcision were carried out. The definitive histopathology study was positive for malignancy and a second surgery (partial penectomy) was performed.

Conclusions

We underline the importance of a correct histopathologic report for aiding the surgeon in determining the most viable surgery in each case, taking into account the medical, legal, psychologic, and social aspects of this type of pathology. We also confirm that good outcome is achieved through adequate surgical management of early-stage disease, as reported in the medical literature.

背景:阴茎癌多发于50 - 70岁的人群，仅占男性泌尿生殖肿瘤的2-5%。然而，其发病率在一些拉丁美洲国家(巴拉圭、巴西)和波多黎各各不相同，据报道，在波多黎各，男性肿瘤的发病率达到10%。阴茎癌的手术是致残的，严重影响了这些患者的生活质量。我们在此描述我们的疾病管理，根据组织病理分期，建议不太激进的管理与肿瘤治疗。目的介绍我国局限性阴茎癌的治疗现状。临床病例:男性，42岁，阴茎可疑病变伴包茎。病变活检和术中组织病理学检查为阴性瘤变。病变切除和包皮环切。最终的组织病理学研究为恶性肿瘤阳性，并进行了第二次手术(部分阴茎切除术)。结论:我们强调正确的组织病理学报告对于帮助外科医生在每个病例中确定最可行的手术的重要性，同时考虑到这类病理的医学、法律、心理和社会方面。我们也证实，如医学文献报道的那样，通过对早期疾病进行适当的手术治疗可以取得良好的结果。

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引用次数: 1

PCUMex survey: Controversies in the management of prostate cancer among Mexican urologists PCUMex调查:墨西哥泌尿科医生在前列腺癌治疗中的争议

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-05-01 DOI: 10.1016/j.uromx.2015.12.007

C.I. Villeda-Sandoval, J.A. Rivera-Ramírez, G. Romero-Veléz, A. Lisker-Cervantes, R.A. Castillejos-Molina, M.S. de Zavaleta

Background

Prostate cancer is the first cause of mortality related to malignancy in Mexican men. Common clinical practice has to be evaluated in order to gain a picture of reality apart from the guidelines.

Aim

To analyze clinical practice among urologists in Mexico in relation to prostate cancer management and to compare the results with current recommendations and guidelines.

Methods

We collected the data from 600 urologists, members of the Sociedad Mexicana de Urología, who were invited by email to answer a survey on their usual decisions when managing controversial aspects of prostate cancer patients.

Results

Quinolones were the most common antibiotic used as prophylaxis in prostate biopsy (75.51%); 10–12 cores were taken in more than 65% of prostate biopsies; and 18.27% of the participants performed limited pelvic lymphadenectomy. Treatment results showed that 10.75% of the urologists surveyed preferred radical prostatectomy as monotherapy in high-risk patients with extraprostatic extension and 60.47% used complete androgen deprivation in metastatic prostate cancer.

Conclusions

There are many areas of opportunity for improvement in our current clinical practice for the management of patients with prostate cancer.

背景:前列腺癌是墨西哥男性恶性肿瘤死亡的第一大原因。必须对常见的临床实践进行评估，以便获得除指南之外的现实情况。目的分析墨西哥泌尿科医生在前列腺癌管理方面的临床实践，并将结果与目前的建议和指南进行比较。方法我们收集了600名泌尿科医生的数据，他们是墨西哥社会Urología的成员，我们通过电子邮件邀请他们回答一项关于他们在处理前列腺癌患者有争议方面的通常决定的调查。结果喹诺酮类药物是前列腺活检中预防使用最多的抗生素(75.51%);超过65%的前列腺活检取了10-12芯;18.27%的参与者行有限盆腔淋巴结切除术。治疗结果显示，10.75%的受访泌尿科医师首选根治性前列腺切除术作为前列腺外伸高危患者的单一治疗方法，60.47%的受访泌尿科医师选择完全雄激素剥夺治疗转移性前列腺癌。结论目前前列腺癌患者的临床治疗还有很多需要改进的地方。

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引用次数: 1

Características de los casos incidentes de cáncer de próstata en los últimos 5 años en un hospital de tercer nivel en México 墨西哥一家三级医院过去5年前列腺癌病例的特征

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2015.11.007

A.A. Cayetano-Alcaraz, J.A. Ramírez-Rivera, M. Sotomayor-de-Zavaleta, R.A. Castillejos-Molina, F. Gabilondo-Navarro, G. Feria-Bernal, F.T. Rodríguez-Covarrubias

Background

In 2008 in Mexico, prostate cancer (CaP) held first place as cause of death due to malignant tumors in men.

Objectives

To describe the clinical and pathologic characteristics of the incident cases of CaP and their treatment.

Material and methods

A descriptive analysis of the new hospital cases of CaP within the time frame of 2010 to 2014 was conducted.

Results

A total of 238 cases were documented, of which 128 (53.8%) were localized disease, 32 (13.4%) were locally advanced disease, and 78 (32.8%) were metastatic disease. The mean age of disease presentation was 66.7 years (SD ± 8.8). The diagnostic methods employed were prostate biopsy in 208 (87.4%) cases, transurethral resection of the prostate (TURP) in 5 (2.1%), lymph node biopsy in 18 (7.6%), and prostate-specific antigen (PSA) plus digital rectal examination in 18 (7.6%). Mean PSA levels were 16 ng/ml in localized disease, 15.7 ng/ml in locally advanced disease, and 389 ng/ml in metastatic disease. The surgical procedures in relation to the cancer were radical prostatectomy (RP) in 153 (64.3%) patients, de-obstructing prostate resection in 12 (5%), and orchiectomy in 11 (4.6%). The main oncologic medical treatment in accordance with CaP extension was androgen deprivation therapy for metastatic disease in 93.6% of the cases, radiotherapy in 62.5% of the cases of locally advanced disease, and chemotherapy in 17.9% of the cases of metastatic disease.

Discussion

The results suggest the need to implement strategies that enable early identification of this pathology.

Conclusions

More than half of the men diagnosed with CaP at a tertiary care hospital in Mexico had localized disease and more than 60% had high-grade tumors.

2008年，在墨西哥，前列腺癌(CaP)在男性恶性肿瘤死亡原因中占据首位。目的探讨急性冠状动脉炎的临床、病理特点及治疗方法。材料与方法对2010 ~ 2014年住院新发CaP病例进行描述性分析。结果238例患者中，局限性疾病128例(53.8%)，局部晚期疾病32例(13.4%)，转移性疾病78例(32.8%)。平均发病年龄为66.7岁(SD±8.8)。诊断方法为前列腺活检208例(87.4%)，经尿道前列腺切除术(TURP) 5例(2.1%)，淋巴结活检18例(7.6%)，前列腺特异性抗原(PSA)加直肠指检18例(7.6%)。局部疾病的平均PSA水平为16 ng/ml，局部晚期疾病为15.7 ng/ml，转移性疾病为389 ng/ml。与癌症相关的外科手术是根治性前列腺切除术(RP) 153例(64.3%)，去梗阻性前列腺切除术12例(5%)，睾丸切除术11例(4.6%)。根据CaP扩展的主要肿瘤医学治疗是93.6%的转移性疾病的雄激素剥夺治疗，62.5%的局部晚期疾病的放疗，17.9%的转移性疾病的化疗。讨论结果表明需要实施能够早期识别这种病理的策略。结论:在墨西哥三级医院诊断为CaP的男性患者中，一半以上为局部疾病，60%以上为高级别肿瘤。

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引用次数: 6

Factores asociados al fracaso en la colocación de catéteres doble J en pacientes con uropatía obstructiva por cáncer 癌症性阻塞性尿路病患者双J导管放置失败的相关因素

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2015.10.005

I. Jiménez-Vázquez , I.A. Reyes-García , A.R. Aragón-Tovar , G.C. Palacios-Saucedo , A. García-Mendoza , A. Michel-Chávez , M.E. Huitrado-Duarte

Aim

To analyze the clinical, imaging, and surgical factors that are associated with failed double-J stent placement in patients with obstructive uropathy due to cancer.

Materials and methods

An analytic, cross-sectional study was conducted. The variables analyzed were: age, sex, oncologic diagnosis, clinical stage, diagnostic time course, treatment received, preoperative laboratory studies (Hb, leuc, Cr, BUN, urea), imaging studies (US or CAT), and the surgical attempt to place the double-J stent. A comparative analysis was done between the failed and successful placement groups. Statistical analysis was carried out using the Mann-Whitney U test and the chi-square test, and finally, the odds ratio with a 95% confidence interval was employed.

Results

Of the 48 patients, 27 had failed double-J stent placement and 21 had successful placement. Risk factors for failed placement were elevated preoperative levels of urea ≥ 40 mg/dL (OR: 16.67, CI: 2.66-134.92 [P = .0001]), creatinine ≥ 2 mg/dL (OR:7.27, CI:1.41-42.25 [P = .004]), and BUN ≥ 40 mg/dL (OR:4.00, CI: 0.93-18.06 [P = .031]) and a low Hb level ≤ 9 mg/dL (OR:6.32, CI:1.37-21.55 [P = .005]), as well as a deformed trigone (OR:3.29, IC:1.18-9.19 [P = .002]).

Conclusions

Elevated preoperative levels of creatinine, urea, and BUN, and a deformed bladder trigone are markers for failed double-J stent placement.

目的分析癌症性梗阻性尿路病变患者双j型支架置入术失败的临床、影像学及手术因素。材料与方法采用分析、横断面研究。分析的变量包括:年龄、性别、肿瘤诊断、临床分期、诊断时间、接受的治疗、术前实验室检查(Hb、leuc、Cr、BUN、尿素)、影像学检查(US或CAT)以及手术放置双j型支架的尝试。在失败和成功的安置组之间进行了比较分析。统计学分析采用Mann-Whitney U检验和卡方检验，最后采用95%置信区间的优势比。结果48例患者中，27例双j型支架置入失败，21例置入成功。术前尿素≥40 mg/dL (OR: 16.67, CI: 2.66-134.92 [P = .0001])、肌酐≥2 mg/dL (OR:7.27, CI:1.41-42.25 [P = .004])、BUN≥40 mg/dL (OR:4.00, CI: 0.93-18.06 [P = .031])、Hb低水平≤9 mg/dL (OR:6.32, CI:1.37-21.55 [P = .005])以及三角区变形(OR:3.29, IC:1.18-9.19 [P = .002])是放置失败的危险因素。结论术前肌酐、尿素、BUN升高及膀胱三角区变形是双j型支架置入失败的标志。

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引用次数: 2

Regresión de metástasis óseas en cáncer de próstata metastásico resistente a castración 耐去势转移性前列腺癌的骨转移消退

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2015.12.002

R. Cortez-Betancourt , M. Pelayo-Nieto , E. Linden-Castro , I.A. Ramírez-Galindo , E.D. Rubio-Arellano , R.C. Rodríguez-Alvarado , A. González-Serrano , J.G. Sierra-Sosa , D. Espinosa-Perezgrovas , J.A. Morales-Covarrubias

Introduction

There have been significant modifications in metastatic castration-resistant prostate cancer management in the last decade, with great changes in the treatment paradigm, even though the disease will ultimately continue to progress despite the currently available treatments.

Case report

A 72-year-old man diagnosed with castration-resistant prostate cancer underwent a bone scintigram that identified metastatic bone lesions. He was treated with abiraterone, with clinical and biochemical response. Follow-up revealed regression of bone metastasis documented in the bone scintigram.

Conclusions

This clinical case shows the particularity of apparent bone lesion regression in the context of metastatic castration-resistant prostate cancer after treatment with abiraterone acetate that also showed sustained clinical and biochemical response.

在过去十年中，转移性去势抵抗性前列腺癌的治疗发生了重大变化，治疗模式发生了巨大变化，尽管目前可用的治疗方法最终仍将继续发展。病例报告:一名72岁的男性被诊断患有去势抵抗性前列腺癌，接受了骨显像检查，确定了转移性骨病变。患者给予阿比特龙治疗，临床及生化反应良好。随访显示骨闪烁图显示骨转移灶消退。结论本病例显示了转移性去势抵抗性前列腺癌患者经醋酸阿比特龙治疗后骨损伤明显消退的特殊性，且临床和生化反应均持续。

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引用次数: 0

Utilidad de la escala S.T.O.N.E. como herramienta de predicción terapéutica en cirugía intrarrenal retrógrada S.T.O.N.E.量表作为逆行肾内手术治疗预测工具的应用

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2016.01.001

I.A. Ramírez-Galindo, A. Alías-Melgar, M. Pelayo-Nieto, E. Linden-Castro, G. Rembis-Ávila, G. Villela-Segura, C. Nájar-Pini, R. Cortez-Betancourt

Background

Retrograde intrarenal surgery (RIS) for the treatment of kidney stones has increased in the last few years. The S.T.O.N.E. score has been described as a reproducible tomographic evaluation tool enabling the complexity of urinary calculi to be estimated, thus establishing predictive factors for therapeutic success.

Aim

To determine the factors that influence the success of RIS in the treatment of kidney stones in 95 patients at a tertiary care hospital in Mexico City, in relation to the S.T.O.N.E. score calculation and the value of each of the stone variables in the corresponding preoperative tomographic study.

Material and methods

In a sample of 95 patients, those that were stone-free and those that presented with residual stones after a single RIS event were identified. The S.T.O.N.E. score was calculated through a preoperative tomographic evaluation. The correlation between the S.T.O.N.E. score and residual stone status was identified through the Pearson test and the individual impact of each of the stone variables was determined through the logistic regression test.

Results

A total of 64 patients were stone-free and 31 patients presented with significant lithiasis. Analysis of the logistic regression test revealed stone size (P = .0127), number (P = .0400), and density (P = .0079) as predictive factors for stone-free status.

Conclusions

The preoperative evaluation with the S.T.O.N.E. score is a predictive tool for RIS therapeutic success. Identification of the variables having greater therapeutic impact will enable better patient selection for RIS as surgical treatment.

背景:逆行肾内手术(RIS)治疗肾结石在过去几年中有所增加。S.T.O.N.E.评分被描述为一种可重复的层析评估工具，可以估计尿路结石的复杂性，从而为治疗成功建立预测因素。目的通过S.T.O.N.E.评分计算和相应术前断层扫描研究中每个结石变量的值，确定影响墨西哥城某三级医院95例肾结石患者RIS治疗成功的因素。材料和方法在95例患者的样本中，确定了无结石和单次RIS事件后出现残留结石的患者。通过术前断层扫描评估计算S.T.O.N.E.评分。通过Pearson检验确定S.T.O.N.E.评分与剩余结石状态之间的相关性，并通过logistic回归检验确定每个结石变量的个体影响。结果64例无结石，31例有明显结石。logistic回归分析显示，结石大小(P = 0.0127)、数量(P = 0.0400)和密度(P = 0.0079)是无结石状态的预测因素。结论术前S.T.O.N.E.评分是RIS治疗成功的预测工具。识别具有更大治疗影响的变量将使患者更好地选择RIS作为手术治疗。

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引用次数: 1

¿Quimioterapia adyuvante en cáncer de pene? Más preguntas que respuestas 在这种情况下，化疗是一种有效的治疗方法。问题多于答案

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2015.11.008

E.I. Bravo-Castro , E.A. Linden-Castro , M.A. Jiménez-Ríos

引用次数: 1

Estudio comparativo de adenomectomía prostática laparoscópica y abierta. ¿Cuál ofrece mejores resultados? 腹腔镜前列腺腺切除术与开放式前列腺腺切除术的比较研究。哪一个效果最好?

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2016.01.007

V.M. Pérez Manzanares , F. Salinas González , R.A. García Vásquez , J. Arriaga Aguilar , M.C. Candia Plata

Background

Standard management of benign prostatic hyperplasia in large volume adenomas is open surgery. With the advent a little over a decade ago of minimally invasive techniques for prostatic adenoma, this trend is changing.

Aim

Given that there are few comparative studies establishing a real difference between open and laparoscopic surgery, the aim of our study was to objectively evaluate their advantages.

Methods

A total of 82 patients were analyzed. They were diagnosed with benign prostatic hyperplasia and were consecutively operated upon. Twenty-four of the patients underwent laparoscopic surgery and 58 had open surgery.

Results

There was significant difference in relation to patient weight (<0.001), which was greater in the laparoscopic adenomectomy group (LA). The two groups had similar results in regard to preoperative studies such as PSA, IPSS, prostate size, and uroflowmetry. The surgical indications were also similar and the most frequent indication was acute urinary retention. Surgery duration was longer in the LA group with statistical significance (127.2 vs. 90.9 min; P≤0.001) and intraoperative blood loss and transfusions were significantly lower in the LA group, based on the Clavien-Dindo classification (450 vs. 738.8 ml; P=0.009 and 0.45 vs. 0.25; P=0.039, respectively). There were no differences between the two procedures in relation to length of hospital stay, postoperative results, or complications (according to the Clavien-Dindo classification).

Conclusions

Both procedures had similar postoperative results and complications, but there was less blood loss and fewer transfusions with the laparoscopic procedure. Surgery duration was longer with the laparoscopic technique and there were no differences in relation to hospital stay.

背景:大容量腺瘤良性前列腺增生的标准治疗方法是开放手术。随着十多年前前列腺腺瘤微创技术的出现，这一趋势正在改变。考虑到目前很少有比较研究能够确定开放手术和腹腔镜手术之间的真正区别，我们研究的目的是客观地评价它们的优势。方法对82例患者的临床资料进行分析。确诊为良性前列腺增生，均行手术治疗。24例患者行腹腔镜手术，58例行开放手术。结果两组患者体重差异有统计学意义(<0.001)，其中腹腔镜腺瘤切除术组(LA)差异更大。两组在术前研究如PSA、IPSS、前列腺大小和尿流测量方面的结果相似。手术指征也相似，最常见的指征是急性尿潴留。LA组手术时间更长，差异有统计学意义(127.2 vs 90.9 min;P≤0.001)，根据Clavien-Dindo分类，LA组术中失血量和输血量显著降低(450 vs. 738.8 ml;P=0.009和0.45 vs. 0.25;分别为P = 0.039)。两种手术在住院时间、术后结果或并发症(根据Clavien-Dindo分类)方面没有差异。结论两种手术的术后结果和并发症相似，但腹腔镜手术的出血量和输血量更少。腹腔镜技术的手术时间更长，与住院时间没有差异。

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引用次数: 1

Acidosis tubular renal distal: diagnóstico en una unidad urológica 远端肾小管酸中毒:泌尿科诊断

Q4 Medicine

Revista mexicana de urologia

Pub Date : 2016-03-01 DOI: 10.1016/j.uromx.2015.12.006

M.C. Cano-García , M.S. Girón-Prieto , M.A. Arrabal-Polo

引用次数: 0