RESUMEN
OBJECTIVE: To investigate what changes are endoscopically evident after glycosaminoglycans (GAGs) therapy by hyaluronic acid (HA) and chondroitin sulphate (CS) (Ialuril®) in female patients affected by bladder pain syndrome(BPS)/ interstitial cystitis (IC) or recurrent urinary tract infections (rUTIs). PATIENTS AND METHODS: 21 female patients over 18 years affected by rUTIs or BPS/IC received intravesical instillation of HA and CS (4 weekly instillations followed by 2 instillations every 2 weeks and 2 instillation monthly). Post-treatment evaluation included cystoscopy and patient assessment of improvement in symptoms and satisfaction on a visual analogue scale (VAS) from 0 to 10. RESULTS: The post-treatment endoscopy showed a positive effect on bladder mucosa morphology. In 2 cases, treatment did not change endoscopic findings and clinical symptoms. In the other patients, when macroscopic features of the bladder mucosa normalized, the clinical picture improved. CONCLUSIONS: GAGs therapy by HA and CS (Ialuril) improves the morphology of bladder mucosa in patients with rUTI or BPS/IC.
Asunto(s)
Sulfatos de Condroitina/administración & dosificación , Cistitis Intersticial/tratamiento farmacológico , Ácido Hialurónico/administración & dosificación , Membrana Mucosa/patología , Vejiga Urinaria/patología , Infecciones Urinarias/tratamiento farmacológico , Adulto , Anciano , Sulfatos de Condroitina/uso terapéutico , Cistitis/tratamiento farmacológico , Cistoscopía , Combinación de Medicamentos , Endoscopía/métodos , Femenino , Glicosaminoglicanos/uso terapéutico , Humanos , Ácido Hialurónico/uso terapéutico , Persona de Mediana Edad , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico , Urotelio/metabolismo , Urotelio/patologíaRESUMEN
In the last decade, we have assisted to the progressive standardization of the surgical technique of robot-assisted radical prostatectomy (RARP). This article describes in details our current surgical technique to perform nerve-sparing RARP. Specifically, we took in consideration the tips, tricks and pitfalls of each step of RARP according to our experience.
Asunto(s)
Laparoscopía/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Robótica , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Selección de Paciente , Prostatectomía/efectos adversos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
In line with the results of general surgeons, who revolutionised the surgical approach and the success rate of ventral hernia repair using synthetic mesh, urologists and gynaecologists recently moved towards the use of prosthesis to augment the native tissues. The rationale was based on the relatively high failure rates of the traditional anterior vaginal compartment repair and the recognition that the native tissue may no longer assume the position, strength or functionality by simple re-approximation. Actually the plethora of mesh or graft material, ranging from absorbable (synthetic and biological) to non-absorbable materials, indicates how uncertain we are about the best management. The surgical results are variable on the basis of 1) the material used (synthetic or biological, absorbable or not absorbable); 2) the position of the mesh (incorporated in the suture, overlay the suture, below or under the fascia); 3) the tension adopted. Major problems concern the complications related to the use of the meshes in urogynaecological surgery and the final message is that surgeons may want to consider adopting use of graft techniques to improve surgical results with care given to carefully monitor complications.