RESUMEN

AIMS: To assess the hypothesis that resiniferatoxin (RTX) can be useful in women with urgency incontinence and idiopathic detrusor overactivity (IDO), we conducted a prospective, double-blind, randomized, placebo-controlled, parallel trial comparing the effects of RTX and placebo. MATERIALS AND METHODS: Fifty-eight patients were randomly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo. Safety and efficacy were evaluated over 4 weeks. The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary. Secondary efficacy endpoint was urodynamic response. Quality of life was measured by the Kings' Health Questionnaire RESULTS: Although improving trends were seen in both groups after the instillations, no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters. RTX instillations were well tolerated with few and self-limited side-effects. CONCLUSION: A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence.

Asunto(s)

Diterpenos/uso terapéutico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Incontinencia Urinaria de Esfuerzo/tratamiento farmacológico , Administración Intravesical , Diterpenos/administración & dosificación , Método Doble Ciego , Emociones , Femenino , Humanos , Neurotoxinas/administración & dosificación , Neurotoxinas/uso terapéutico , Placebos , Calidad de Vida , Conducta Social , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/psicología , Incontinencia Urinaria de Esfuerzo/psicología , Micción/efectos de los fármacos , Micción/fisiología

RESUMEN

The fibroepithelial polyp of the urethra is rare in adults. Hematuria and obstructive urinary symptoms are the most common findings. The treatment of choice is endoscopic resection and the prognosis for these lesions is excellent. There is no previous report on recurrence. We describe 2 new cases, with 1 of them presenting recurrence following surgical resection.

Asunto(s)

Pólipos/patología , Enfermedades Uretrales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos/cirugía , Pronóstico , Recurrencia , Enfermedades Uretrales/cirugía

RESUMEN

Post-prostatectomy urinary incontinence is an uncommon complication of adenomectomies, occurring in approximately 1% of cases and being more frequent following radical prostatectomies. There is a significant implication in the quality of life for these patients. The surgical techniques employed for its treatment are the implantation of an artificial sphincter, peri-urethral injections and suburethral slings. Considering the low efficacy of peri-urethral injections and the high cost of artificial sphincters, we present in this work a technical modification of the suburethral sling, whose preliminary results are satisfactory. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra. In addition to such aspects the autologous aponeurosis does not have a cost except for a short prolongation of the surgical act.

RESUMEN

OBJECTIVES: In spite of its historical use, published data about phytotherapic products is characterized by the absence of well conducted studies, leading to conflictive and indefinite results about efficiency and safety of theses drugs. In that sense, we have analyzed the results of a combination of Pygeum africanum and stinging nettle (Urtica dioica) extracts in patients with benign prostatic hyperplasia (BPH), based in a double-blind, randomized, placebo-controlled protocol. MATERIALS AND METHODS: We have selected, according to inclusion and exclusion criteria, only patients with >or=50 years, presenting urinary symptoms assessed by the International Prostatic Symptoms Score (IPSS), with minimum score of 12, and Quality of Life (QoL) index of at least 3 points, rectal examination consistent with BPH, and maximum urinary flow rate (Q(max)) between 5 and 15 mL/s. Phytotherapic and placebo groups were formed by 27 and 22 patients, respectively. The major variables analyzed during the study were IPSS variation, Q(max), and side effects. Reduction of >or=30% and >or=50% in IPSS were the parameters used to define a clinically significant response (CSR). We have also analyzed >or=30% and >or=50% Q(max) increases. RESULTS: After six months of treatment we did not observe significant differences in clinical improvement potential between the phytotherapic combination and placebo groups. Percent IPSS drop of 21.6% in the phytotherapic group was similar to 19.7% obtained in the placebo group (p=0.928). Neither we observed any difference (p=0.530) for QoL improvement between phytotherapic (9.26%) and placebo (5.98%) groups. The alterations of Q(max) followed the trend line observed in clinical data, with no significant difference (p=0.463) in Q(max) increasing percent between phytotherapic (17.2%) and placebo (13.3%) groups. The CSR evaluation of clinical and urodynamic data was also similar between the groups. CONCLUSION: The combination of 25mg Pygeum africanum and 300mg stinging nettle extracts produced clinical and urodynamic effects similar to placebo in a group of HBP patients.

RESUMEN

INTRODUCTION: We report the case of a 74 years old patient presenting bowel lesion in a percutaneous renal surgery to extract a 2.5cm diameter stone. CASE REPORT: The access to percutaneous nephrostolithotomy was performed between the 11th and 12th left ribs at the posterior axillary line. An abdominal transversal pad was placed and a guide was passed down the ureter with no difficulty. Surgical time was of approximately 40 minutes. Antegrade pielography performed at the end of the procedure was normal. In the first post-operative day, the patient presented severe pain and abdominal defense. An additional descendent pielography was performed gently pulling the nephrostomy catheter, thus contrasting the bowel. The patient underwent an exploratory laparotomy where lacerations in left colon external wall and a bowel transfixing lesion were found. Non-absorbable sutures in two layers were performed. The patient presented a good progress with no occurrences during post-operative period, and was discharged in one week.