F.M. Sánchez-Martín

Cistoprostatectomía radical robótica: análisis oncológico y funcional

Resumen Introduccion La cirugia laparoscopica robotizada da Vinci, ha demostrado en la prostatectomia radical, optimos resultados funcionales y oncologicos con menor curva de aprendizaje, mayor comodidad y vision para el cirujano, y correcta preservacion de las bandeletas neurovasculares. Esto ha dado lugar a que iniciar la experiencia con cistectomia radical robotica (CRR), fuera de nuestro pais. Objetivos Revisar nuestra experiencia inicial en CRR, valorando los resultados quirurgicos y funcionales obtenidos, y complicaciones inmediatas y a corto plazo. Pacientes y metodo Entre diciembre del 2007 y enero del 2009 hemos realizado nueve cistoprostatectomias radicales roboticas y en siete de los nueve casos con linfadenectomia (LDN) robotica. En 5 pacientes por tumor musculo-invasivo y 4 por no musculoinvasivo de alto riesgo. La mediana de edad fue 57 anos (rango 34-81). La derivacion urinaria se realizo extracorporeamente, en 3 casos un conducto ileal, en los 6 restantes una neovejiga tipo Studer, en 3 de estos 6 casos la anastomosis uretro-neovejiga se realizo intracorporeamente. Resultados El tiempo medio total de cirugia fue 300 minutos (rango 280-420) en el conducto ileal y 360 (rango 330-540) en el Studer. Ningun caso requirio conversion ni transfusion sanguinea. La mediana de ganglios extraidos mediante LDN robotica fue 10 (rango 6-18). La AP de la pieza revelo 3 pT0, 2 CIS, 3 pT3, 1 pT4b (margenes positivos). Con mediana de seguimiento de 7 meses no se ha observado ningun implante peritoneal y unicamente una estenosis ureteral. Se inicio dieta oral en 5 casos a las 48 horas. De los 6 pacientes con funcion sexual conservada preoperatoria y seguimiento > 3 meses, 2 tenian ereccion completa al mes, 2 a los 3 y 6 meses, y los 2 restantes presentan ereccion completa con inhib de la 5PDE a los 3 y 9 meses. Todos los pacientes con neovejiga presentan correcta continencia diurna. La estancia media hospitalaria fue de 8,5 dias (rango 7-19). Conclusiones La cistectomia radical mas linfadenectomia robotica, con reconstruccion extracorporea de la derivacion urinaria ofrece buenos resultados quirurgicos y funcionales tempranos. La preservacion cuidadosa de las bandeletas neurovasculares en esta cirugia radical pelvica permite obtener excelentes resultados en la funcion sexual y miccional.

Cólico renal: Revisión de la literatura y evidencia científica

RENAL COLIC: REVISION OF LITERATURE AND SCIENTIFIC EVIDENCE In recent years diagnosis and treatment of acute renal colic have changed thanks to the introduction of new radiological procedures that allow with high reliability to establish obstructive cause and a better treatment. In the other hand, there are multiple clinical studies that show the most effective treatments for acute crisis. The aim of this revision is to update the diagnostic and therapeutic aspects of renal colic which were modified recently, and allowed to break some classic concepts without scientific evidence.

Componente quístico del cáncer renal: Revisión conceptual

Resumen El componente quistico del cancer renal (CR) aparece en el estudio radiologico y queda consolidado con el examen anatomopatologico. El concepto “cancer renal quistico” o “tumor renal quistico” es de uso habitual y comprende una serie de entidades que van desde los CR con patron de crecimiento quistico a aquellos que poseen cavidades pseudoquisticas o se hallan imbricados en cualquiera de las enfermedades renales que presentan quistes renales. Diversas publicaciones utilizan de forma indistinta el calificativo “quistico” sin esperar al estudio anatomopatologico, provocando confusion en la terminologia. La gran variabilidad en la forma de presentacion tanto del CR como de las enfermedades quisticas renales produce distintas formas de presentacion radiologica en que se mezclan areas solidas y otras de contenido liquido, aunque solo el examen patologico podra afirmar que se trata de un CR quistico genuino. Solo el CR con patron de crecimiento quistico y el carcinoma multilocular quistico pueden ser llamados con propiedad tumores renales quisticos. Para el resto de entidades, en especial durante el estudio iconografico, es mas adecuado utilizar expresiones no concluyentes como “masa renal de configuracion quistica” o “tumor renal de aspecto quistico”

La Iniciativa Open Access (OAI) en la literatura científica

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urologicas Espanolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English.

The Open Access Initiative (OAI) in the scientific literature

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urológicas Españolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English.

Implicaciones del déficit de vitamina D en el paciente litiásico y en la población general

CONTEXT AND OBJECTIVE Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.