Asunto(s)
Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Estrógenos/uso terapéutico , Enfermedades Uretrales/diagnóstico , Enfermedades Uretrales/tratamiento farmacológico , Anciano , Terapia de Reemplazo de Estrógeno , Femenino , Humanos , Prolapso , Resultado del TratamientoRESUMEN
AIM: To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. PATIENTS AND METHODS: The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40-83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. RESULTS: All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15-38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. CONCLUSIONS: The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.
Asunto(s)
Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIMS: To review the management of Wilms' tumour. METHODS: A search of the literature was performed using the PubMed database (1966 to May 2006) with the search terms 'Wilms' and either 'tumour/tumor' or 'cancer' or 'carcinoma'. This was augmented by manual searches of publications. FINDINGS: The success of clinical trials in Wilms' tumour patients over the past 30 years has led to an overall survival of 85% and the introduction of less aggressive chemotherapeutic regimes for patients. Large randomised controlled trials have been published on the management of Wilms' tumour by various collaborative groups, including the National Wilms' Tumour Study Group (NWTSG) in North America and the Société Internationale d'Oncologie Pédiatrique (SIOP) plus the United Kingdom Children's Cancer Study Group (UKCCSG) in Europe. CONCLUSIONS: Controversy exists as to the best approach to the management of these children with regard to neoadjuvant chemotherapy. Challenges remain in the identification of histological and molecular risk factors for the stratification of treatment intensity.
Asunto(s)
Neoplasias Renales/terapia , Tumor de Wilms/terapia , Terapia Combinada/tendencias , Humanos , Resultado del TratamientoRESUMEN
Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.
Asunto(s)
Priapismo/terapia , Adulto , Factores de Edad , Algoritmos , Niño , Humanos , Lactante , Masculino , Persona de Mediana Edad , Priapismo/diagnóstico , Priapismo/etiología , Recuperación de la FunciónRESUMEN
Prostate cancer is one of the most commonly diagnosed and potentially devastating cancers in men, throughout the world. However, the clinical manifestation of this disease varies greatly, from indolent tumours, requiring little or no treatment, to those aggressive cancers which require radical therapies. Prostate cancer, like all other cancers, develops and progresses as a consequence of an accumulation of genetic changes. While several putative genes have been isolated for the development of breast, ovarian and colon cancer, the aetiology and pathogenesis of prostate cancer remains poorly understood. In this review, we discuss important genetic markers in early, metastatic and hormone refractory prostate cancer which may, in the future, be used as markers for diagnosis and prognosis, as well as targets for therapeutic intervention.
Asunto(s)
Neoplasias de la Próstata/genética , Biomarcadores de Tumor , Perfilación de la Expresión Génica , Marcadores Genéticos , Predisposición Genética a la Enfermedad/genética , Humanos , Masculino , Mutación , Polimorfismo Genético , Neoplasias de la Próstata/fisiopatologíaRESUMEN
Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it.
Asunto(s)
Disreflexia Autónoma/terapia , Enfermedad Aguda , Disreflexia Autónoma/diagnóstico , Disreflexia Autónoma/etiología , Urgencias Médicas , Tratamiento de Urgencia , HumanosAsunto(s)
Disreflexia Autónoma , Enfermedades Urológicas , Disreflexia Autónoma/diagnóstico , Disreflexia Autónoma/etiología , Disreflexia Autónoma/terapia , Humanos , Terminología como Asunto , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/etiología , Enfermedades Urológicas/terapiaRESUMEN
Benign intratesticular cysts are rare, but recognition is essential to prevent unnecessary surgical intervention. The diagnostic dilemma is to differentiate these cysts from testicular malignancy. As they are extremely uncommon, experience of their management is limited and controversial. We present a case of a simple intratesticular cyst and discuss the diagnostic and management principles.
Asunto(s)
Quistes/diagnóstico por imagen , Enfermedades Testiculares/diagnóstico por imagen , Anciano , Quistes/terapia , Humanos , Masculino , Enfermedades Testiculares/terapia , UltrasonografíaRESUMEN
Testicular torsion is a surgical emergency that requires prompt exploration if testicular viability is to be maintained. Although rare, it is essential to be aware that it may occur despite previous fixation (orchidopexy). Testicular torsion occurring after previous orchidopexy is rare, but recognition of this possibility is essential to prevent testicular infarction and subsequent orchidectomy. During scrotal exploration a wide variety of methods for orchidopexy exist. We present a case of testicular torsion despite previous fixation and discuss the merits of various techniques available for orchidopexy.
Asunto(s)
Torsión del Cordón Espermático/cirugía , Técnicas de Sutura , Enfermedad Aguda , Adulto , Urgencias Médicas , Humanos , Masculino , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
Testicular torsion is a true vascular emergency-prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6 hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.