OBJECTIVES: Frequently, the term “quality of life” has been used to justify personal and professional decisions in all fields of medicine. Nowadays, quality of life studies are based on development and validation of sensitive measures of patient outcomes, incorporating functional status and perceived health status. Thus, quality of life has become an outcome as important as survival and effectiveness.METHODS: A systematic review using Pubmed and Medline was performed, searching for papers concerning health related quality of life and urology. The most relevant articles where questionnaires and interviews were described and validated were listed.RESULTS: Based on psychometric proprieties, a search between 1970 and 2007 identified a total of 25 recommendable articles with generic inventories and specific modules that have been developed, validated and used in clinical practice or research. Historical aspects, quality of life concepts, validation of questionnaires and structured interviews, and most used instruments in generic health-related quality of life, general urology and urological oncology have been discussed.CONCLUSIONS: A brief review of historic background of health related quality of life and urology was performed.
OBJECTIVES: Fournier’s gangrene is adevastating infection, which includes the genital, peri-neal and / or perianal regions. It is potentially fatal,and affects any age and gender. The severity index forFournier’s gangrene has been described; it is useful forevaluating the prognosis of these patients.Our goal is to report our experience with this diseaseover the past 5 years and evaluate the index in retros-pect.METHODS: We analyzed medical records of patientswith Fournier gangrene over the last 5 years at the Uni-versity Hospital “Dr. José E. González”.RESULTS: We reviewed 50 cases, male gender waspredominant (96%), mean age 47.5 years, diabetesmellitus was found in 80%, neurogenic bladder in 10%,2% HIV positive. The most frequent sites of origin of in-fection were scrotum (52%) and perineum (38%), themost common pathogen E. coli and Enteroccocus faeca-lis (48 and 28% respectively). The death rate was 12%.The average severity index was 5.64.DISCUSSION: In our hospital, Fournier’s gangrene israre. Nevertheless, there is a rapid diagnosis protocoland therapeutic management is performed immediately.Until now, the immediate surgical treatment and earlyinitiation of antibiotic therapy remains the best therapeu-tic option.CONCLUSION: There is a relationship between the in-dex of severity and patient survival, which may becomea useful parameter in evaluating these patients
OBJECTIVES: To study quality of life in patients from the health area of Zamora diagnosed of prostate adenocarcinoma between 2000-2005 treated with maximal androgen blockade (MAB). To evaluate the pharmacoeconomics of the treatment.METHODS: Basal, 12-month, 24 –month and 36-month application of the health-related quality of life measurement instrument EORTC QLQ-C30 to the population sample (n= 111), as well as a control sample (n= 100). Comparative study of outcomes: between groups; between different time measurements in MAB patients; and inter-categories/ -intervals of some variables in patients with hormonal deprivation therapy (third year of follow-up). Analysis of health-related quality of life global outcomes (QLQ-C30 + QLQ-PR25). Description of the pharmaceutical expenses in androgen blockade patients. Cost-utility analysis by means of quality-adjusted life years (QALYs) obtained using preference-based weighted index from the EUROQOL 5-D tool.RESULTS: Hot flushes and sexual field worsening as mean expressions related to hormonal suppression. Treated patients had worse subjective perception of health condition and quality of life, in opposition to non-tumoral individuals. Positive bone scan, was a negative-influence factor on quality of life. Most patients undergoing MAB needed cost-utility figures of less than 5000 Euros/ QALY.CONCLUSIONS: There was a negative initial repercussion of MAB on quality of life, although tinged according to the different fields studied. The economic impact of this therapy on overall pharmaceutical expenses is relative.
Este extenso estudio supone poder manejar datos propios de nuestro sistema nacional de salud y compararlos con los datos ya conocidos por otros países. Si bien no he podido conocer la cifra cruda total de pacientes del estudio.
OBJECTIVES: To design and develop the fourth generation in endoscopy after the rigid, semi-rigid and flexible instruments. This next generation technology has been named SolidFlex™, and it was designed by a surgeon based on many years of research with the objective to provide easier and faster solutions for physicians when performing endoscopic procedures.METHODS: This new endoscope called SolidFlex™ has been brought to light with the latest technology to provide surgeons of every age the capabilities to carry out any possible endoscopic procedure. SolidFlex™ is state-of-the-art in both design and construction, giving the instrument a much better balance with only one third of the weight of the usual flexible endoscope. The Instrument is ergonomic, intuitive (instinctive perception) and coherent, meaning that the handle control moves the instrument’s active flexible section towards predictable, pre-selected areas, driving the procedure fluidly throughout. It provides the stability of a rigid and semi-rigid instrument with the exploration capabilities of the flexible endoscope in order to achieve the best means of rendering a patient 100% stone free.RESULTS: The SolidFlex™ ureteroscope prototype has retrieved urinary stones in 9 patients and 11 renal units. These procedures were divided in two groups: Group I, pre-stented after double “J” withdrawal for a previous renal colic episode. Group II, during the acute renal colic episode. Ureteral dilatation was carried out only in Group II and after dilatation in both groups, insertion up to the renal pelvis or the area were the obstruction was present, took only a matter of 15 seconds at the most. All procedures could be completed in each group and stones in the renal papilla from 200 nm, to 4 mm in any given papilla were removed either by laser energy, retrieved with a basket or both. Patients did not experience any pain or major discomfort after the procedure, and no analgesic medication was required, nor requested by any of the patients.CONCLUSIONS: The new SolidFlex™ technology has been tested in surgery and proven to solve most of the difficulties faced by surgeons when performing endoscopic surgery. The surgeon can perform surgery comfortably seated, so that he/she can easily introduce and maneuver the instrument, and introduce operating tools without help or coordination from anyone else during critical moments such as stone extraction. A urologist made the SolidFlex™ research and development for the benefit of physicians and patients, and it does solve many of the issues and limitations that surgeons face today with the rigid, semi-rigid and flexible endoscope technology.
OBJECTIVES: Prostate cancer tends to spreadto regional lymph nodes and bone, and, to a lesser degree,to lung, liver, and brain. Metastases in other locations areexceptional.To review the frequency and clinical characteristics of me-tastasis to subcutaneous cellular tissue in adenocarcinomaof the prostate.METHODS: The case of a 71-year-old man diagnosed ofadenocarcinoma of the prostate is reported. The patientunderwent radical prostatectomy and artificial sphincter forstress urinary incontinence.RESULTS: During follow-up the patient showed biochemicalprogression, local recurrence, and bone metastasis. The di-sease metastasized in the subcutaneous tissue around thereservoir of the artificial sphincter.CONCLUSIONS: Prostate cancer is highly prevalent in ourpart of the world. The clinical finding of metastasis in organsother than bone or regional lymph nodes is accompanied bya short survival. Metastases in subcutaneous tissue may beunderdiagnosed due to its indolent clinical course and pos-sible absence of PSA elevation. In any case, subcutaneousmetastases have an unfavorable prognosis
OBJECTIVES: To report 2 cases of median raphe cysts, 1 in the penis and the other in the perineum.METHOD: Two cases of median raphe cyst are described; the first was treated by surgery and the second required no treatment.RESULTS: The surgical patient experienced no complications and was asymptomatic with no recurrence at 2 years.CONCLUSIONS: Median raphe cysts are a rare, benign condition of uncertain etiology. Treatment consists on simple excision.
OBJECTIVES: We report a case of urachalremnant disease and review the literature.METHODS/RESULTS: We present the case of an urachalcyst in a 13-year-old patient who was admitted to the emer-gency department with acute abdominal pain. Differentialdiagnosis of his symptoms was made with other diseasessuch as appendicitis and inflammatory bowel disease.CONCLUSIONS: Urachal remnant diseases are rare andthey usually present during the neonatal period with feverand wet navel, lower abdominal pain around the middleline, palpable mass and urination symptoms with or withouturinary infections. The presentation as acute abdominal painin an older child is less common, and its differential diagno-sis must be performed with other abdominal or pelvic acutediseases. The most appropriate imaging technique is an ul-trasound exam
OBJECTIVES: We present a case of giantcyst of the rete-testisMETHODS/RESULTS: 85 year-old patient on follow-up forprostate cancer with maximum androgen blockade (MAB)treatment consults for a left hemiscrotum increase in sizeover a 2-month period. We performed bilateral orchiec-tomy confirming the histopathological diagnosis of cysticdilatation of the rete-testis sized 11x11x9cm.CONCLUSIONS: This case of cystic degeneration of therete-testis, with a size out of common (11x11x9cm versusmedium size in the literature: 3x3x3cm), could be relatedwith an androgen-estrogen misbalance caused by a MABin a prostate cancer context
OBJECTIVE: To report the clinical and radiological data of a 23-year-woman with bilateral angiomyolipoma and Tuberous Sclerosis with conservative treatment. METHODS: The patient underwent conservative urological management, based on clinical and complementary tests` data (ultrasonography, CT scanning, excretory urogram, and laboratory). Monitoring was carried out in external consultation by the uroncology group. In some occasions she was hospitalized due to distant geographical factors. RESULTS: This patient provides long-term outcome of AML with Tuberous Sclerosis followed by repeated evaluation to define the conservative management or not. Ultrasonound and CT scan were two basic studies to maintain conservative treatment, as well as a good clinical evaluation.CONCLUSIONS: Renal lesions associated with tuberous sclerosis are frequent and serious. Monitoring should be based on a careful monitoring since the renal lesions are the second death cause after the lesions of the nervous system. This case report provides long-term outcome of AML with tuberous sclerosis, that can be followed expectantly with repeated evaluations to define the clinical significance.
OBJECTIVES: To report one case of metastatic paratesticular rhabdomyosarcoma in a 14 years old patient, classified as stage IIb (IRSG).METHODS: After treatment with radical surgery (orchiectomy and lymphadenectomy), polychemotherapy and radiotherapy, showed good evolution initially.RESULTS: 12 months after surgery the patient is disease free. CONCLUSIONS: Adjuvant treatment is very important in the prognosis of this kind of tumors