RESUMEN
PURPOSE: In a randomized study, we analyzed the treatment results of ureterorenoscopy (URS) and shockwave lithotripsy (SWL) for extended-mid and distal ureteral stones. We investigated also, for reasons of cost effectiveness, the factors influencing the outcome, the complications, and the need for auxiliary procedures. PATIENTS AND METHODS: In three regional hospitals, we selected 156 patients with extended-mid and distal ureteral stones. After randomization, 87 were treated with URS, and 69 with SWL. The treatment results were studied in relation to complications, the need for auxiliary procedures and stone factors, urinary tract infection (UTI), dilatation, and kidney function. RESULTS: After retreatment of 45% of the patients, the stone-free rate after 12 weeks in the SWL group was 51%. After a retreatment rate of 9% of the patients in the URS group, the stone-free rate was 91%. Including the number of auxiliary procedures, we calculated the Efficiency Quotient (EQ) as 0.50 for SWL and 0.38 for URS. After correction and redefinition of auxiliary procedures, the EQ was 0.66. The mean treatment time for SWL was 52 minutes and for URS 39 minutes. General anesthesia was more frequently needed in URS patients. Complications occurred more often in the URS group (22 v 3 and 24 v 13, respectively). These were mostly mild, and all could be treated with a double-J stent, antibiotics, or analgetics. A lower stone-free rate was achieved in patients with larger (> or =11 mm) stones (75% v 85% for smaller stones in the URS group and 17% v 73% in the SWL group. In the URS group, the stone-free rate of patients with extended-mid ureteral stones was lower than that of patients with distal ureteral stones. Calculating the costs for URS and SWL appeared impossible because of the differences in available equipment. CONCLUSION: The stone-free rate after URS is much higher than after SWL, and the EQ in our series was strongly dependent on definitions. The decision about how to treat a patient with an extended-mid or distal ureteral stone therefore should not be made primarily on the basis of cost effectiveness but rather on the basis of the availability of proper equipment, the experience of the urologist, and the preference of the patient.
Asunto(s)
Litotricia/métodos , Cálculos Ureterales/terapia , Ureteroscopía , Adolescente , Adulto , Anciano , Femenino , Humanos , Litotricia/efectos adversos , Litotripsia por Láser , Masculino , Persona de Mediana Edad , Retratamiento , Resultado del Tratamiento , Ureteroscopía/efectos adversosRESUMEN
PURPOSE: To assess the pharmacodynamic equivalence of the new 10.8 mg. goserelin depot with the current 3.6 mg. depot 3 studies were performed in patients with advanced prostate cancer. MATERIALS AND METHODS: In 2 comparative studies 160 patients were randomized for dosing every 12 weeks using the 10.8 mg. depot or every 4 weeks using the 3.6 mg. depot. In the noncomparative study 35 patients received the 10.8 mg. depot. Blood sampling for serum testosterone and evaluation of toxicity was done during the 48-week study period. RESULTS: Serum testosterone profiles of the 10.8 and 3.6 mg. goserlin depots were similar with testosterone levels decreasing into the castrate range by day 21 after depot administration. The safety profile of 10.8 mg. goserelin is comparable to that of the current monthly depot with the main side effects related to androgen deprivation. CONCLUSIONS: The new long acting depot was pharmacologically equivalent, and well tolerated locally and systemically, and will offer added convenience to patients and health care personnel.
Asunto(s)
Antineoplásicos Hormonales/administración & dosificación , Goserelina/administración & dosificación , Neoplasias de la Próstata/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antineoplásicos Hormonales/efectos adversos , Preparaciones de Acción Retardada , Goserelina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Testosterona/sangreRESUMEN
A new depot formulation of the LHRH analogue Zoladex (goserelin acetate) has been developed which releases the drug over a period of at least 3 months as judged by measurement of drug content in depots at intervals after insertion in male rats and by the suppression of oestrogen secretion and oestrus in female rats. This formulation is based on the lactide/glycolide polymer system used for the standard 1-month Zoladex depot, but the dose has been increased to 10.8 mg and the characteristics have been modified to enable a longer release of drug to be achieved. Thirty-eight patients with histologically proven, locally advanced (stage T3 or T4) and/or metastatic prostate cancer were treated with this new longer acting LHRH analogue depot formulation containing 10.8 mg Zoladex. After initial increase of serum testosterone in the first week of therapy, castration levels were reached in all patients after 4 weeks and this was maintained for more than 14 weeks. At the time of depot exhaustion, when escape from castration levels of androgen occurred, all patients received a single injection of a standard 1-month depot containing 3.6 mg Zoladex which restored castration levels of androgen thus showing that the pituitary gland was again suppressed. The tolerance and acceptability of the longer-acting depot is high and comparable to the 1-month depot. Taking into account social and psychological factors, patients with advanced prostate carcinoma will soon be able to be treated with a longer acting LHRH depot formulation every 3 months an alternative of the 1-month depot now widely used clinically.
Asunto(s)
Antineoplásicos/farmacocinética , Buserelina/análogos & derivados , Hipófisis/efectos de los fármacos , Neoplasias de la Próstata/tratamiento farmacológico , Testosterona/sangre , Anciano , Anciano de 80 o más Años , Buserelina/farmacocinética , Tolerancia a Medicamentos , Goserelina , Humanos , Hormona Luteinizante/sangre , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/secundarioRESUMEN
In the post-operative follow-up of 24 patients who received a continent Kock pouch for urinary diversion, several complications were encountered, including hydronephrosis, stone formation and valve dysfunction, resulting in reflux and/or urinary incontinence. After comparing findings on ultrasound with those obtained by Koch pouch cystography, intravenous urography, plain abdominal radiography, Kock pouch endoscopy and operation, we consider ultrasound to be an important technique in the follow-up, especially in non-symptomatic patients. All cases of hydronephrosis and pouch calculi were detected by ultrasound and no false positive findings were encountered in either group. A good correlation is demonstrated between nipple length, as measured by ultrasound, and valve dysfunction, clinically important only for the afferent nipple.
Asunto(s)
Complicaciones Posoperatorias/diagnóstico , Ultrasonografía , Derivación Urinaria/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Hidronefrosis/diagnóstico , Íleon/cirugía , Masculino , Persona de Mediana Edad , Cálculos Urinarios/diagnósticoRESUMEN
During a 9-year period in our clinic 4 patients were seen with signet-ring cell carcinoma. 2 patients had primary signet-ring cell carcinoma of the bladder, 1 of the prostate. In the 4th case the tumor was located near the penoscrotal angle of the urethra. These cases are reviewed and their main characteristics, mentioned in the literature, are discussed briefly.