Showing papers by "Javier C. Angulo published in 2011"

Visfatin Impairs Endothelium-Dependent Relaxation in Rat and Human Mesenteric Microvessels through Nicotinamide Phosphoribosyltransferase Activity

Abstract: Visfatin, also known as extracellular pre-B-cell colony-enhancing factor (PBEF) and nicotinamide phosphoribosyltransferase (Nampt), is an adipocytokine whose circulating levels are enhanced in metabolic disorders, such as type 2 diabetes mellitus and obesity. Circulating visfatin levels have been positively associated with vascular damage and endothelial dysfunction. Here, we investigated the ability of visfatin to directly impair vascular reactivity in mesenteric microvessels from both male Sprague-Dawley rats and patients undergoing non-urgent, non-septic abdominal surgery. The pre-incubation of rat microvessels with visfatin (50 and 100 ng/mL) did not modify the contractile response to noradrenaline (1 pmol/L to 30 µmol/L), as determined using a small vessel myograph. However, visfatin (10 to 100 ng/mL) concentration-dependently impaired the relaxation to acetylcholine (ACh; 100 pmol/L to 3 µmol/L), without interfering with the endothelium-independent relaxation to sodium nitroprusside (1 nmol/L to 3 µmol/L). In both cultured human umbilical vein endothelial cells and rat microvascular preparations, visfatin (50 ng/mL) stimulated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, as determined by lucigenin-derived chemiluminiscence. The relaxation to ACh impaired by visfatin was restored by the NADPH oxidase inhibitor apocynin (10 µmol/L). Additionally, the Nampt inhibitor APO866 (10 mmol/L to 10 µmol/L), but not an insulin receptor-blocking antibody, also prevented the stimulation of NADPH oxidase and the relaxation impairment elicited by visfatin. Accordingly, the product of Nampt activity nicotinamide mononucleotide (100 nmol/L to 1 mmol/L) stimulated endothelial NADPH oxidase activity and concentration-dependently impaired ACh-induced vasorelaxation. In human mesenteric microvessels pre-contracted with 35 mmol/L potassium chloride, the endothelium-dependent vasodilation to bradykinin (1 nmol/L to 3 µmol/L) was equally impaired by visfatin and restored upon co-incubation with APO866. In conclusion, visfatin impairs endothelium-dependent relaxation through a mechanism involving NADPH oxidase stimulation and relying on Nampt enzymatic activity, and therefore arises as a potential new player in the development of endothelial dysfunction.

[Etiology and sensitivity of uropathogens identified in uncomplicated lower urinary tract infections in women (ARESC Study): implications on empiric therapy]

Abstract: Background and objective To determine the etiology and susceptibility of uropathogens identified in women with uncomplicated lower urinary tract infections (UTI). Patients and methods In a multicenter study (ARESC) in 9 Spanish hospitals, 803 female patients with uncomplicated cystitis were consecutively enrolled and evaluated to identify the uropathogens and their susceptibility to 9 antimicrobials. Results Of 803 patients with uncomplicated cystitis, 784 patients were included. A positive urine culture was found in 87.7% of the samples. Of the 650 pathogens isolated, Escherichia coli (E. coli) was the most frequent (79.2%) followed by Staphylococcus saprophyticus (4.4%), Proteus mirabilis (4.3%), Enterococcus faecalis (3.2%) and Klebsiella pneumoniae (2.3%). E. coli showed a high rate of susceptibility to phosphomycin (97.2%), nitrofurantoin (94.1%) and somewhat lower to ciprofloxacin (88.1%). Fluorquinolone resistance rates were higher among postmenopausal women (17 versus 10%). E. coli was highly resistant to ampicillin (65%) and cotrimoxazole (34%) and 25% of the strains were resistant to amoxicillin/clavulanalic acid and cefuroxime. Conclusions In Spain, E. coli shows high resistance rates to widely used antimicrobial antibiotics. Phosphomycin and nitrofurantoin have a high in vitro activity. Taking into account practical aspects such as convenience (only one dose), and the influence of the amount of fluorquinolone use on enterobacteriaceae and other microorganisms resistance levels, phosphomycin trometamol represents the option of first choice for the empirical treatment of uncomplicated cystitis in women.

Etiología y sensibilidad de los uropatógenos identificados en infecciones urinarias bajas no complicadas de la mujer (Estudio ARESC): implicaciones en la terapia empírica

Abstract: Resumen Fundamento y objetivo Determinar la etiologia y la sensibilidad de los uropatogenos en mujeres con infecciones del tracto urinario (ITU) bajas no complicadas. Pacientes y metodo Estudio multicentrico ARESC de 9 hospitales espanoles, que incluyo de forma consecutiva 803 mujeres, de edades entre 18 y 65 anos, con cistitis no complicada, con el fin de identificar la etiologia y evaluar su sensibilidad a 9 antimicrobianos. Resultados De 803 pacientes consecutivas con ITU baja no complicada, fueron finalmente incluidas 784 pacientes. El urocultivo fue positivo en el 87,7% de las muestras. De un total de 650 uropatogenos, Escherichia coli (E. coli) fue el mas frecuente (79,2%), seguido por Staphylococcus saprophyticus (4,4%), Proteus mirabilis (4,3%), Enterococcus faecalis (3,2%) y Klebsiella pneumoniae (2,3%). E. coli mostro una elevada sensibilidad a fosfomicina (97,2%), nitrofurantoina (94,1%) y algo menor a ciprofloxacino (88,1%). Las tasas de resistencia a fluorquinolonas fueron mas elevadas en mujeres postmenopausicas (17 frente a 10%). E. coli sigue presentando unas elevadas resistencias a ampicilina (65%) y a cotrimoxazol (34%), y en la actualidad, aproximadamente un 25% de las cepas son resistentes a amoxicilina/clavulanico y cefuroxima. Conclusiones En Espana se observan elevados indices de resistencia de E. coli a antibioticos de amplio uso. Fosfomicina y nitrofurantoina preservan una elevada actividad in vitro . Considerando otros aspectos practicos, como la posologia (una sola dosis) y la influencia del consumo total de quinolonas sobre los niveles de resistencia en enterobacterias y en otros microorganismos, fosfomicina trometamol representa una alternativa empirica de primera eleccion para la cistitis no complicada de la mujer.

Topical treatment of contact dermatitis by pine processionary caterpillar

Abstract: Skin contact dermatitis by pine processionary (Thaumetopoea pityocampa) is a public health problem of increasing significance. The authors present here the case of a 65-year-old man who was diagnosed with processionary caterpillar dermatitis. Patient was treated with topical potassium dobesilate 5% cream twice a day for 2 days. An improvement occurred soon after treatment.

Effect of fesoterodine 4 mg on bladder diary and patient-reported outcomes during the first week of treatment in subjects with overactive bladder.

Abstract: Objective:To assess the onset of efficacy of fesoterodine 4 mg versus placebo in subjects with overactive bladder (OAB) symptomsResearch design and methods:Subjects who reported OAB symptoms for ≥3 months and recorded ≥8 micturitions and ≥1 urgency urinary incontinence (UUI) episode per 24 hours in 3-day baseline diaries were randomized to fesoterodine 4 mg, tolterodine extended release (ER) 4 mg, or placebo. This is an analysis of first week data from a 12-week, double-blind trial.ClinicalTrials.gov unique ID: NCT00444925Main outcome measures:Baseline to week 1 changes in 3-day bladder diary variables, Patient Perception of Bladder Condition (PPBC), and Urgency Perception Scale (UPS) scores reported by subjects receiving fesoterodine 4 mg or placebo.Results:By week 1, fesoterodine 4 mg (n = 679) was associated with significantly greater improvements compared with placebo (n = 334) in micturitions, urgency, severe urgency and UUI episodes, frequency-urgency sum, and MVV per 24 hours and 3-day diar...

Nefrectomía parcial laparoscópica

Abstract: Resumen Objetivo Analizar el resultado quirurgico y oncologico de una experiencia prospectiva con nefrectomia parcial laparoscopica. Se describe la tecnica quirurgica y los resultados oncologicos conseguidos a medio plazo. Material y metodos Fueron intervenidos 60 pacientes mediante esta tecnica entre junio de 2005 y junio de 2009. La edad media de los pacientes fue 58,9 (38-77 anos), siendo 40 (66,7%) varones y 20 (33,3%) mujeres. El IMC medio fue 26,8 (18-40). La lateralidad fue 28 (46,7%) tumores derechos y 32 (53,3%) izquierdos, localizandose en el polo superior en 14 (23,3%) pacientes, en la zona media en 13 (21,7%), en el polo inferior en 22 (36,7%) y en la zona hiliar en 11 (18,3%). En 23 (38,3%) casos el tumor se localizo en la valva anterior, en 24 (40%) en la valva posterior, en 10 (16,7%) en el borde externo y en 3 (5%) en el borde interno. El tamano medio tumoral en la TAC fue 3,3 (1-6,4) cm y en la pieza quirurgica 3,1 (1,2-7) cm. Resultados El tiempo medio quirurgico fue 107,17 (50-185) minutos, con un tiempo de isquemia caliente de 33 (0-70) minutos. En 56 casos (93,3%) habia una sola arteria y en 4 (6,7%) dos. Se realizo clampaje solo de la arteria en 15 pacientes (25%), de la arteria y la vena en 44 (73,3%) y no se realizo clampaje en uno (1,7%). Se realizo reparacion de la via urinaria en 32 pacientes (53,3%), dejandose cateter ureteral en todos ellos. Precisaron transfusion el 20% de los pacientes (12). Se produjeron complicaciones intraoperatorias en 5 pacientes (8,7%). Estas fueron: una lesion esplenica que requirio esplenectomia (1,7%), un desgarro de la vena cava que se suturo laparoscopicamente (1,7%) y tres casos de sangrado por mal funcionamiento del «bulldog» (5%). Se produjeron complicaciones postquirurgicas en 11 pacientes (18,7%) y estas fueron: un hematoma de pared que requirio reintervencion (1,7%), una fistula urinaria que termino en atrofia renal y posterior nefrectomia (1,7%), tres hematomas intracavitarios que se resolvieron de manera conservadora (5%), una fistula arteriovenosa que preciso embolizacion selectiva (1,7%), un urinoma que se soluciono con drenaje percutaneo (1,7%) y tres casos de fiebre postoperatoria (5%). Hubo margenes positivos en un paciente (1,7%). En 49 casos (81,7%) la histologia fue carcinoma renal, en 8 (13,3%) oncocitoma, en dos (3,3%) angiomiolipoma y en uno (1,7%) metastasis. La estancia media fue 5 (3-29) dias. El seguimiento medio fue de 31 (12-61) meses. Se produjo una recidiva local a los 16 meses (tumor primario hiliar de 2,5 cm) y una metastasis en la suprarrenal ipsilateral a los 34 meses (tumor primario de 5,6 cm en el polo inferior izquierdo). Conclusiones En esta serie de nefrectomia parcial laparoscopica se demuestra la baja tasa de complicaciones, los buenos resultados oncologicos y la baja tasa de recidiva a corto plazo. Se precisa mayor numero de pacientes y seguimiento para afianzar los resultados oncologicos y funcionales de esta tecnica quirurgica.

[Detection and molecular staging of bladder cancer using real-time RT-PCR for gelatinases (MMP-2, MMP-9) and TIMP-2 in peripheral blood].

Abstract: Introduction Molecular staging of bladder cancer based on the detection of mRNA of urothelial specific genes in circulating cancer cells has been inconclusive. We analyze whether real-time RT-PCR evaluation of gelatinases (MMP-9, MMP-2) and TIMP-2 in peripheral blood allows diagnosing and characterizing patients with bladder neoplasm. Materials and method Total RNA is extracted from circulating blood cells in 42 individuals (11 healthy controls, 31 patients with bladder cancer in different stages) and real-time RT-PCR performed using specific primers for MMP-9, MMP-2, TIMP-2 and ribosomal 18S. The quantification values of mRNA are described as relative to 18S mRNA (ΔΔCt method) and the results are blindly compared with data obtained from histological diagnosis and clinical staging. Results Normalized levels of MMP-9 and MMP-2 mRNA are higher in patients with cancer than controls (1.82 ± 0.6 times and 2.7 ± 0.6 times, respectively; P Conclusions Both non-invasive bladder tumor recognition and molecular staging of the disease is possible using real-time RT-PCR-based detection of gelatinases and TIMP-2 in peripheral blood. The ability to distinguish metastatic disease is higher for MMP-9 but MMP-2 discriminates better levels of tumor invasion. Further investigation in this field could yield promising results regarding molecular evaluation of bladder neoplasia.

Laparoscopic partial nephrectomy

Abstract: Objetives To analyze the surgical and oncologic outcome of prospective experience with laparoscopic partial nephrectomy. We describe the surgical technique and mid-term oncological results achieved. Material and methods 60 patients were operated with this technique between June 2005 and June 2009. The mean age of patients was 58.9 [38–77] years, being 40 (66.7%) males and 20 (33.3%) women. The average BMI was 26.8 [18–40]. Laterality was 28 (46.7%) right tumors and 32 (53.3%) left, being located in the upper pole in 14 (23.3%) patients, in the middle third in 13 (21.7%), in the lower pole in 22 (36.7%), and hiliar region in 11 (18.3%). In 23 cases (38.3%) tumors were located in the anterior valve, in 24 (40%) in the posterior valve, in 10 (16.7%) at the outer edge and 3 (5%) at the inner edge. The average size tumor on CT was 3.3 [1–6.4] cm and in the surgical specimen 3.1 [1.2–7] cm. Results The mean operative time was 107.17 [50–185] min, with a warm ischemia time of 33 [0–70] min. In 56 cases (93.3%) there was a single artery and in 4 (6.7%) cases there were 2 arteries. The artery was clamped alone in 15 patients (25%), artery and vein in 44 (73.3%) and no clamping was performed in 1 (1.7%). We repaired the urinary tract in 32 patients (53.3%), leaving ureteral catheter in all patients. 20% of patients (12) required transfusion. Intraoperative complications occurred in 5 patients (8.7%). These were: 1 splenic injury requiring splenectomy (1.7%), 1 tear in the vena cava, sutured laparoscopically (1.7%) and 3 cases of bleeding due to bulldog malfunction (5%). Postoperative complications occurred in 11 patients (18.7%) and these were: 1 wall hematoma that required reoperation (1.7%), 1 urinary fistula ending in renal atrophy and subsequent nephrectomy (1.7%), 3 intracavitary hematomas which resolved conservatively (5%), 1 arteriovenous fistula that needed embolization (1.7%), 1 urinoma that was resolved with percutaneous drainage (1.7%) and 3 cases of postoperative fever (5%). Margins were positive in 1 patient (1.7%). In 49 cases (81.7%) histology was renal cell carcinoma, in 8 (13.3%) oncocytoma, in 2 (3.3%) angiomyolipoma and 1 (1.7%) metastasis. The average stay was 5 [3–29] days. Median follow up was 31 [12–61] months. There was a local recurrence at 16 months (hiliar primary tumor 2.5 cm) and an ipsilateral adrenal metastasis at 34 months (primary tumor 5.6 cm in left lower pole). Conclusions In this series of laparoscopic partial nephrectomy low rate of complications, good oncologic results and low recurrence rate in the short term are shown. More patients and further monitoring is required to strengthen the functional and oncological outcomes of this surgical technique.

Tratamiento de la estenosis de uréter distal mediante reimplantación urétero-vesical laparoscópica

Abstract: Resumen Introduccion analizar los resultados obtenidos para tratar la estenosis de ureter iliaco-pelviano sin tumor activo mediante reimplantacion laparoscopica en vejiga psoica. Material y metodo en un periodo de 4 anos hemos practicado reimplantacion ureteral laparoscopica en vejiga psoica a 6 pacientes (derecho/izquierdo 1:1; hombre/mujer 1:2; edad media 59,2 anos, rango 47-85). En 4 casos la etiologia fue iatrogenica y en 2 idiopatica. En los pacientes con causa idiopatica o antecedentes de tumor urotelial (4 casos en total) se realizo reseccion ureteral laparoscopica con rodete vesical, cistorrafia y linfadenectomia ipsilateral antes de la reimplantacion. Se movilizo ampliamente la vejiga y se fijo al tendon del psoas. La reimplantacion se realizo mediante tecnica mixta intra-extravesical con tunel submucoso (Politano) en un caso, y mediante tecnica extravesical con tunel submucoso (Goodwin) en el resto. El seguimiento medio fue 26 meses (rango 18-34). Resultados no hubo reconversion a cirugia abierta y la duracion fue 230 minutos en el caso de la reimplantacion tipo Politano y 120 minutos (rango 75-150) para la reimplantacion extravesical. La estancia postoperatoria fue 3,2 dias (rango 2-5). No se produjeron complicaciones intra o postoperatorias. El estudio histologico mostro en todos los casos fibrosis ureteral sin signos de malignidad y ausencia de metastasis ganglionares. Ningun paciente ha presentado reestenosis ni deterioro de la funcion renal durante el seguimiento. Conclusiones en casos seleccionados la reimplantacion ureteral laparoscopica es una tecnica minimamente invasiva, eficaz y segura para el tratamiento de las estenosis ureterales distales sin tumor activo. Por su simplicidad de ejecucion es preferible la reimplantacion extravesical.

Treatment of distal ureteral stricture by laparoscopic ureterovesical reimplantation

Abstract: Introduction To analyse the results achieved to treat iliac or pelvic ureteric stricture using laparoscopic reimplantation of the ureter in a psoic bladder. Material and method In a four-year period, we performed laparoscopic ureteral reimplantation in a psoic bladder in 6 patients (right/left 1:1; male/female 1:2; mean age 59.2 years, range 47-87). In 4 cases the lesion was iatrogenic and in 2 cases idiopathic. Ureteral resection with bladder cuff and cystorraphy followed by ipsilateral lymph node dissection was performed in idiopathic cases or those with history of previous urothelial tumour (4 cases in total) before ureteral reimplantation. Bladder was extensively mobilized and fixed to minor psoas tendon before performing ureteroneocystostomy. Mixed intra and extravesical technique with submucosal tunnel (Politano) was used in a case and in the remaining 5 cases extravesical technique with submucosal tunnel (Goodwin) was used. Mean follow-up was 26 months (range 18–34). Results There was no need to convert to open surgery. Time of surgery was 230 minutes in the case treated with Politano ureteroneocystostomy and 120 (range 75–150) in those treated purely extravesically. The mean hospital stay was 3.2 days (range 2–5). There were no intra or postoperative complications. Histologic assessment always revealed ureteral fibrosis and in 2 cases accompanying granulomatous inflammation and dysplasia. No patient suffered re-stricture or impairment in renal function during follow-up. Conclusions Laparoscopic ureteral reimplantation is an effective and safe minimally invasive technique to treat benign distal stricture of the ureter. Simplicity of extravesical reimplantation has an advantage over its intravesical counterpart.

Efficacy of the fibroblast growth factor inhibitor 2,5-dihydroxyphenylsulfonate in basal cell carcinoma: A histopathological and inmunohistochemical study

Abstract: Background: Fibroblast growth factors (FGFs) are variously implicated in skin tumorigenesis where they may be involved in the enhancement of tumoral cell proliferation and viability, induction of angiogenesis, and stimulation of tumor invasiveness. Objective: To investigate the efficacy and safety of the FGF inhibitor 2,5-dihydroxyphenylsulfonate (2,5-DHPS) in 2.5% cream for the treatment of basal cell carcinoma (BCC) and characterize its mechanism of action at a histological level. Methods: After 2 weeks of histopathological diagnosis confirmation, patients initiated treatment. 2,5-DHPS cream was applied twice daily for 2 months to nine patients with BCC. Skin biopsies were performed before and after treatment. The specimens were subjected to inmunohistochemical staining with antibodies to CD34+ and Ki-67 and to in situ apoptosis assay (TUNEL staining). Results: The use of 2,5-DHPS achieved excellent results in all patients: CD34+ and Ki-67 were significantly downregulated; TUNEL staining reveal...

Vesiculectomy with laparoscopic partial prostatectomy in the treatment of primary adenocarcinoma of the seminal vesicle with carcinomatous transformation of the ejaculatory duct

Abstract: Introduction Primary adenocarcinoma of the seminal vesicle is an extremely rare condition. Some cases have been described in relation to congenital seminal vesicle cysts, which is often also associated with agenesia or ipsilateral renal disgenesia. The rareness of this type of lesions makes it difficult to plan a regulated surgical approach for them, although they are often treated by simple exeresis or exenteration, depending on their stage at the beginning. Materials and methods We present a new surgical technique that consists of radical vesiculectomy associated with laparoscopic partial prostatectomy (total segmentary) of the central area to successfully treat primary seminal vesicle adenocarcinoma in a young man who was diagnosed through an azoospermia study. Results A study of the scan (MRI) with diffusion and the transrectal biopsy of the mass allowed us to make a thorough preoperative evaluation of the case, confirming the malignity and precociousness of the lesion. The laparoscopic approach allowed us to perform a pelvic lymphadenectomy and transperitoneal exeresis, including the central prostate area and suture of the posterior face of the urethra at the height of the apex of the prostate. The wall of the seminal cyst lesion confirmed infiltrating clear cell adenocarcinoma and non-invasive adenocarcinoma in the prostate segment of the central gland in the light of the ejaculatory conduct with “in situ” growth. Thus, the surgical specimen allowed radical exeresis with negative margins, guaranteeing minimally invasive surgery with preservation of continence and erection. Conclusion We describe a new integral approach for the radical surgery of localized primary adenocarcinoma of the seminal vesicle. Despite its exceptional nature, the case allowed for a double reflection: (a) the study of diffusion with MRI may suggest the diagnosis of malignity in this type of lesions; and (b) radical surgical treatment must include exeresis of the central portion of the prostate gland.

Vesiculectomía con prostatectomía parcial laparoscópica en el tratamiento del adenocarcinoma primario de vesícula seminal con transformación carcinomatosa del conducto eyaculador

Abstract: Resumen Introduccion El adenocarcinoma primario de la vesicula seminal es una condicion extremadamente rara. Se han descrito algunos casos en relacion con quistes congenitos de la vesicula seminal, que a menudo se asocian tambien con agenesia o disgenesia renal ipsilateral. La rareza de este tipo de lesiones dificulta la planificacion de un planteamiento quirurgico reglado de las mismas, aunque habitualmente se tratan mediante exeresis simple o exenteracion, segun el estadio de las mismas al comienzo. Material y metodos Presentamos una nueva tecnica quirurgica, consistente en vesiculectomia radical asociada a prostatectomia parcial laparoscopica (segmentaria total) de la zona central para tratar con exito un adenocarcinoma primario de vesicula seminal en un varon joven, al que se le detecto por un estudio de azoospermia. Resultados El estudio de imagen mediante resonancia magnetica (RM) con difusion y la biopsia transrectal de la masa permitio una evaluacion preoperatoria minuciosa del caso, confirmando malignidad y la precocidad de la lesion. El abordaje laparoscopico permitio llevar a cabo linfadenectomia pelvica y exeresis transperitoneal, incluyendo la zona central prostatica y suturando la cara posterior de la uretra a la altura del apex prostatico. La lesion quistica seminal confirmo en su pared un adenocarcinoma de celulas claras infiltrante, y el segmento prostatico de la glandula central un adenocarcinoma no invasivo en la luz del conducto eyaculador con crecimiento in situ. Asi, el especimen quirurgico permitio la exeresis radical con margenes negativos, garantizando el caracter de cirugia minimamente invasiva, con preservacion de la continencia y de la ereccion. Conclusion Se describe un nuevo abordaje integral para el planteamiento quirurgico radical del adenocarcinoma primario de vesicula seminal localizado. A pesar de su caracter excepcional, el caso permite llevar a cabo una doble reflexion: a) el estudio de difusion con RM puede sugerir el diagnostico de malignidad en este tipo de lesiones; y b) el tratamiento quirurgico radical debe incluir la exeresis de la porcion central de la glandula prostatica.

Reconstructive treatment of female urethral estenosis secondary to erosion by suburethral tape

Abstract: Introduction Female urethral stricture secondary to erosion by suburethral sling is an uncommon problem with a difficult solution. Ventral vaginal rotation flaps or buccal mucosa dorsal grafts are not useful because this type of stricture is very proximal (close to the bladder neck) and the vagina is thinned. We present our experience in the management this problem using excision of the involved urethral tract, associated to bladder mucosa flap and vaginal sling using transverse vaginal flap to repair the weakened vaginal wall. Material and methods Three females with urethral stricture secondary to urethral erosion of their sling were treated with a technique of combined urethroplasty with bladder flap and vaginal reinforcement with pediculated vaginal flap transferred as a mini-sling. Two of the patients suffered chronic urinary retention and preoperative placement of urethral catheter was not possible. The patients were evaluated 12, 36 and 55 months after surgery, respectively. Results Surgery was performed without complications. Results were satisfactory in all the patients, reaching good postoperative micturition caliber and without incontinence at follow-up. Conclusion Patients with suburethral erosion due to a synthetic sling and secondary severe urethral stricture require total extirpation of the mesh and complete reconstruction of the urethro-vaginal septum. Tension-free urethral suture and the use of vaginal sling with the technique we describe herein, are two useful technical tips for this problem.

Tratamiento reconstructivo de la estenosis uretral femenina secundaria a erosión por cinta suburetral

Abstract: Resumen Introduccion La estenosis uretral femenina secundaria a erosion por cabestrillo suburetral es un problema poco frecuente y de dificil solucion. Los colgajos ventrales de rotacion vaginal o los injertos dorsales de mucosa bucal no son utiles, porque este tipo de estenosis es demasiado proximal (cercana al cuello vesical) y la vagina se encuentra adelgazada. Presentamos nuestra experiencia en el manejo de este problema utilizando la escision del tracto uretral afecto, asociada a colgajo de mucosa vesical y a cabestrillo vaginal mediante colgajo vaginal trasverso para reparar la endeble pared vaginal. Material y metodos Tres mujeres con estenosis uretral secundaria a erosion uretral de cabestrillo fueron tratadas con una tecnica combinada de plastia uretral con colgajo vesical y refuerzo vaginal mediante colgajo vaginal pediculado transferido a modo de mini-cabestrillo. Dos de las pacientes se encontraban en retencion urinaria cronica, y no fue posible la colocacion preoperatoria de cateter uretral. Las pacientes fueron evaluadas tras la cirugia a 12, 36 y 55 meses, respectivamente. Resultados La cirugia fue practicada sin complicaciones. Los resultados fueron satisfactorios en todas las pacientes, alcanzando buen calibre miccional postoperatorio y encontrandose sin incontinencia en el momento del seguimiento. Conclusion Los pacientes con erosion suburetral por un cabestrillo sintetico y estenosis uretral secundaria severa necesitan exeresis total de la malla y reconstruccion completa del tabique uretro-vaginal. La sutura uretral sin tension y el empleo de cabestrillo vaginal con la tecnica que describimos son dos puntos tecnicos de gran utilidad para este problema.

[Laparoscopic extraperitoneal prostatic adenomectomy: description of the surgical technique].

Abstract: Historicamente el tratamiento quirurgico de la Hiperplasia Benigna de Prostata (HBP) se ha realizado mediante abordaje quirurgico convencional empleando las tecnicas descritas por Terence Millin y Peter Freyer, en aquellas glandulas de volumen superior a los 75-80 gramos, Debido al avance tecnologico durante las tres ultimas decadas, en la actualidad, se aplican varias tecnicas minimamente invasivas con buenos resultados en el tratamiento de la HBP. La incorporacion del abordaje laparoscopico a la cirugia pelviana ha permitido el desarrollo tecnico de la adenomectomia siguiendo las mismas directrices empleadas en los abordajes convencionales. El objetivo de este articulo es describir detalladamente, paso a paso, la tecnica quirurgica de la adenomectomia laparoscopica para el tratamiento de la HBP, en glandulas con un tamano superior a 60 cc., realizando un estudio retrospectivo y descriptivo de los resultados preliminares obtenidos en el postoperatorio inmediato de nuestra serie inicial.

The efficacy and tolerability of mirabegron, a potent and selective ß3-adrenoceptor agonist, compared with placebo and tolterodine slow release in patients with overactive bladder – results from a European–Australian Phase III trial

Abstract: 1. St Mary's Hospital, Imperial College, Urogynaecology Department, London, UK, 2. Infanta Leonor Hospital, Department of Urology, Madrid, Spain, 3. American Hospital Dubai, Department of Urology, Dubai, United Arab Emirates, 4. Hospital Universitario de Getafe, Department of Urology, Madrid, Spain, 5. Astellas Pharma Global Development-EU, Medical Science department, Leiderdorp, The Netherlands, 6. Astellas Pharma Global Development, Clinical research, Leiderdorp, The Netherlands

Long-term effectiveness of dobesilate in the treatment of papulopustular rosacea

Abstract: This case report is a representative example from a study directed to assess the long-term clinical benefit of dobesilate in rosacea in five enrolled papulopustular rosacea patients with several years of disease, treated topically with 5% potassium dobesilate cream for 3 weeks. The patient suffered papulopustular rosacea for more than 10 years, during which she received topical metronidazole and azelaic acid, and systemic doxycycline therapies without satisfactory improvement. Dobesilate treatment promoted improvement of rosacea symptoms and signs. Two years after treatment the patient still shows a good facial cosmesis.

Re-exéresis mediante cirugía de Mohs de carcinomas basocelulares de la cabeza previamente extirpados con afectación de márgenes: Mohs Micrographic Surgery for Repeat Excision of Basal Cell Carcinomas on the Head With Positive Margins

Abstract: Resumen Introduccion La actitud ante los carcinomas basocelulares que han sido extirpados con margenes afectos es controvertida en la literatura. Frente a casos que no recidivan incluso tras muchos anos de seguimiento, hay riesgo de complicaciones en aquellos que si lo hacen. Podrian existir factores que ayuden a escoger la mejor opcion terapeutica para los carcinomas basocelulares localizados en la cabeza y extirpados con margenes afectos. Material y metodos Se seleccionaron 46 pacientes tratados mediante cirugia de Mohs por haber sido previamente extirpados con afectacion de margenes. Se valoro que factores se asociaron a la ausencia de restos tumorales y que factores estaban asociados a la obtencion de margenes negativos con un unico estadio. Resultados No se consiguio ninguna relacion significativa con el sexo, el tamano tumoral, el margen que estaba afecto (lateral, profundo o ambos), el tiempo de evolucion, el numero de tratamientos previos, el tipo histologico ni la localizacion. Hubo una cierta tendencia a encontrar mas frecuentemente restos tumorales en las areas perioficiales de tumores con ambos margenes afectos, y a necesitar un unico estadio en los tumores de menos de 1,2 cm y con menos de 5 anos de evolucion. Conclusiones No existen datos concluyentes que permitan definir en que casos puede no ser necesaria la reextirpacion ni en cuales puede ser suficiente una exeresis convencional. La mejor opcion para el tratamiento de estos tumores es la cirugia de Mohs, aunque podria ser razonable realizar exeresis convencional en tumores pequenos de poco tiempo de evolucion en localizaciones de bajo riesgo.

Original article Effect of fesoterodine 4mg on bladder diary and patient-reported outcomes during the first week of treatment in subjects with overactive bladder

Abstract: Objective: To assess the onset of efficacy of fesoterodine 4 mg versus placebo in subjects with overactive bladder (OAB) symptoms

Técnica de cistectomía radical laparoscópica y derivación urinaria ortotópica en el varón

Abstract: Radical cystectomy with extended pelvic lymphadenectomy remains the treatment of choice for muscle invasive bladder cancer and non-metastatic chorion-invasive high grade tumors resistant to treatment with intravesical chemotherapy. During the last decade the procedure has been refined and we have acquired the skills necessary to perform it using the laparoscopic approach. In this way, the oncologic and functional outcomes obtained can be compared to those of its open counterpart. This article describes in detail the technique of radical cystoprostatectomy and urinary diversion in the male patient conducted by our group in an attempt to improve the knowledge and spread of this always difficult procedure.

Manejo endourológico y tratamiento con láser de los tumores del tracto urinario superior

Abstract: La propension a la recurrencia de los tumores de celulas transicionales del tracto urinario superior y las limitaciones de la endoscopia del mismo han hecho de la nefroureterectomia el gold standard de tratamiento de este tipo de tumores, aunque en ocasiones los riesgos derivados de la cirugia mayor abierta sobrepasen a los derivados de la propia enfermedad. De este modo, la exeresis de toda la unidad renal puede no ser precisa cuando el tumor puede controlarse con seguridad de forma endoscopica. Los avances recientes en la tecnologia y las tecnicas han permitido el manejo endourologico eficaz del carcinoma de celulas transicionales del tracto urinario superior.