28 August 2022, Volume 75 Issue 6

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  • Review
    Pedro Romero Pérez
    Archivos Españoles de Urología. 2022, 75(6): 482-488. https://doi.org/10.56434/j.arch.esp.urol.20227506.72
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    Introduction and Objectives: Fosfomycin has been with us for more than 50 years; however the history of its discovery is largely unknown. The objective of this article is to recover and make known its lost history.

    Material and Methods: Retrospective review study on the history of the discovery of fosfomycin based on articles and documents located in Medline/PubMed and Google between 1945 and 2020. For the search of articles in PubMed the MeSH keywords fosfomycin OR fosfomycin history, fosfomycin discovery, Streptomyces fradiae, and in Google the free terms; fosfomycin, fosfomycin history, fosfomycin discovery, Streptomyces fradiae were used. All the papers found were reviewed and those containing any historical review of interest to this research were selected for study.

    Results: We found 3500 articles on fosfomycin, of which 32 (0.9%) dealt with some aspect related to its discovery, and 21 corresponded to its history (0.6%), divided between 13 publications and 7 press releases, 8 to the genus Streptomyces (0.2%) and 3 to fosfomycin (0.1%).

    Conclusions: The story of the discovery of fosfomycin begins with the finding of the bacterium Streptomyces fradiae in a soil sample from mount Montgó between Dénia and Jávea (Alicante). There is little published literature and the existing one is mostly incomplete. Some medical publications and press releases have made it possible to recover its history.

  • Article
    Álvaro José Montiel-Jarquín, Margarita Vargas-Huerta, Sandra Maldonado-Castañeda, Arturo García-Galicia, Sebastián Ibarra-Zamarrón, Jorge Loría-Castellanos
    Archivos Españoles de Urología. 2022, 75(6): 489-493. https://doi.org/10.56434/j.arch.esp.urol.20227506.73
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    Background: The testicular cancer prevails in the third decade of life, the care cost increases with higher staging of the disease.

    Objective: Compare the direct costs of medical and surgical attention for testicular cancer in early and advanced stages in a Third Level Medical Facility.

    Material and Methods: Process study, direct costs of medical attention are evaluated. Number of laboratory studies, imaging studies, and medical and surgical treatment were analyzed. The patients were divided into 2 groups: group 1 early stages and group 2 advanced stages. Mann Whitney U test was used for the difference between groups.

    Results: There were 10 patients in each group, Group 1: 8 (80%) seminomas and 2 (20%) non-seminoma, Group 2: 4 (40%) seminomas and 6 (60%) non-seminomas. The average cost of care in Group 2 is higher than in Group 1, $288,827.90 and $145,911.70 Mexican pesos respectively (p=0.00578).

    Conclusions: The direct cost of medical attention is higher in the advanced stages compared to the early stages.

  • Article
    Mónica Ferradás-Galloso, Alejandra Alonso-Calvete, Yoana González-González, Iria Da Cuña-Carrera
    Archivos Españoles de Urología. 2022, 75(6): 494-506. https://doi.org/10.56434/j.arch.esp.urol.20227506.74
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    Introduction: The most used physiotherapy treatment is the pelvic floor muscle training. Other factors are involved in the control of urination, such as the management of abdominal pressure and the activity of the muscles and fascia of the lumbopelvic region and this could be trained through generalized therapeutic exercise, which is defined as an intervention aimed at restoring musculoskeletal, cardiopulmonary and neurological function. The objective of this review is to evaluate the effects of therapeutic exercise, combined or not with analytical training of the pelvic floor muscles, on urinary incontinence in women over 18 years of age, by reviewing the scientific literature.

    Objective: To assess the effects of therapy exercise other than or combined with pelvic floor muscle training on urinary incontinence in women over 18 years.

    Material and Methods: An article research was done between 11th January and 7th February, 2021 on the following databases: Pubmed, Medline, Cinahl, Web Of Science, Sport Discus and PEDro using the search terms “Urinary Incontinence” and “Exercise Therapy”.

    Results: An average of 245 results were obtained, of which 10 were selected after applying the eligibility criteria. The interventions of the analyzed articles are divided into two groups. First, a group where muscles of the abdominal-pelvic-perineal region are worked (hypopressives, yoga and strength of the abdominal muscles, resisted hip rotation...). Secondly, another group where muscles in general are worked (weight training, flexibility, balance and toning and cardiovascular training).

    Conclusion: Urinary incontinence treated with therapy exercise other than the pelvic floor muscles training, or combined with it, suggest improvements in symptoms.

  • Article
    Nigel P Murray, Socrates Aedo, Cynthia Fuentealba, Eduardo Reyes, Aníbal Salazar
    Archivos Españoles de Urología. 2022, 75(6): 507-516. https://doi.org/10.56434/j.arch.esp.urol.20227506.75
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    Objective: Incorporate the immune function as determined by the absolute lymphocyte count (ALC) into the CAPRA-S risk stratification score to determine if predictive values could be improved.

    Materials and Methods: The clinical pathological findings in the surgical specimen and total PSA were used to define the three CAPRA-S risk groups. One month after surgery and at each follow up total PSA and the ALC were determined, until biochemical failure (BF) or the end of the study period. A cut off value of <1,000 lymphocytes/mm3 was used to define lymphocytopenia (LCP). Each CAPRA-S group was sub-divided based on the presence or absence of LCP. Kaplan-Meier biochemical failure free survival (BFFS) curves and restricted mean biochemical failure free survival times were calculated for each group.

    Results: 404 patients participated of whom 103 (25.5%) underwent BF. 270 men were CAPRA-S low risk (LR), 89 intermediate risk (IR) and 45 high risk (HR), of whom LCP was found in 22 (8%) of low risk, 24 (27%) of intermediate risk and 17 (38%) of high risk men. LCP was significantly associated with a higher PSA, higher Gleason and CAPRA-S scores and BF. HRs were 1.76 for IR, 2.49 for HR and 1.29 for LCP. Five-year BFFS for men without LCP, LR 93.5%, IR 61% and HR 36%, for those with LCP, LR 55%, IR 25% and HR 6%. All patients with LCP and IR or HR scores relapsed within 6 years. 10 year BFFS for men without LCP were 71% LR, 43% IR and 23% HR, LR with LCP 16%. Men with BF had increasing LCP approximately 18 months before BF.

    Conclusions: The incorporation of the ALC taken one month after surgery with the CAPRA-S improves risk stratification; decreases in the ALC suggest that BF is occuring. These results need to be confirmed with larger studies.

  • Article
    Pedro de Pablos-Rodríguez, Carlos Torrecilla Ortiz, Sergi Colom Feixas, Jose María Cuadrado Campaña, Victor Tamés Chacón, Francesc Vigués Julià
    Archivos Españoles de Urología. 2022, 75(6): 517-523. https://doi.org/10.56434/j.arch.esp.urol.20227506.76
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    Objective: To assess our experience in flexible ureteroscopy (fURS) in major ambulatory surgery (MAS) and to detect variables related to unplanned medical assistance after surgery.

    Material & Methods: We conducted a retrospective study among patients with renal stones undergoing a fURS from 2014 to 2019 in MAS at our hospital. Variables: Age, gender, ASA physical status, type of anesthetic technique performed, stone characteristics, influence of double J stent before or after surgery, and postoperative complications according to the Clavien-Dindo modified classification. We evaluated variables related to hospital readmission or visit to the emergency room after surgery.

    Results: A total of 222 consecutive fURS for stone disease were performed in MAS. Patients’ average age was 52.9 ± 13.91 years old. The mean operating time was 57.86 ± 21.11 minutes. The mean stone size was 1.92 ± 1.43 with a diameter of 10.01 ± 4.24 mm. 47.3% of patients had a double J stent before fURS, and in 35.14% of cases, a stent was placed after surgery. 7.65% of patients required unplanned hospitalization. 14.86% of patients presented to the emergency room in the following month after surgery. Among them, one-third consulted for symptoms related to the double J. Patients who carried a double J stent before the fURS had 64% less risk of visiting the emergency department in the following month after surgery [OR = 0,363; IC95% (0.153-0.798)]. All other variables (age, gender, operating time...) did not modify the risk of unplanned medical assistance.

    Conclusion: The low complication rate following flexible ureteroscopy allows its performance as an ambulatory surgery. Patients who carry double J stent before the procedure have less risk of requiring unplanned medical assistance after the surgery.

  • Article
    Patricio Mendez, Ricardo Lineros, Duban Ospina, Maximiliano Ringa, Eduardo Eyheremendy
    Archivos Españoles de Urología. 2022, 75(6): 524-531. https://doi.org/10.37554/es-j.arch.esp.urol-20210515-3507-27
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    Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications.

    Objective: To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients.

    Method: Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020.

    Results: 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization.

    Conclusion: EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients.

  • Article
    Rubén Martín Alelú, Cristina Tordable Ojeda, Daniel Cabezalí Barbancho, Andrés Gómez Fraile
    Archivos Españoles de Urología. 2022, 75(6): 532-538. https://doi.org/10.56434/j.arch.esp.urol.20227506.78
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    Purpose: The diuretic renal scan (MAG3) continues being the gold standard to test the improvement of the urinary drainage after pyeloplasty. Recent researches suggest that there are certain parameters of ultrasound (US) that may indicate an adequate urinary drainage during the follow-up. Our aim is to prove if the measurement of the anteroposterior diameter (APD) of renal pelvis by USS after the pyeloplasty may be a valid screening method to select those patients who also require a MAG3.

    Methods: We retrospectively study the patients who underwent pyeloplasty between 2010 and 2019. The sample was divided in two groups depending of the increase or non-increase in the pelvic APD on postoperative US. The results of the MAG3 and the US of both groups were compared in relation to the presence or absence of obstruction and the need for repyeloplasty.

    Results: We included a total of 124 pyeloplasty, with a median age of 6 months (IQR 4–36); 12 patients showed an increase in pelvic APD, of those 5 had an obstructive MAG3 and renal function >10%, requiring reoperation. Of the 112 patients in whom the pelvic APD did not increase, only one patient needed reoperation due to obstruction in the MAG3, showing the same pre and postoperative pelvic APD. The sensitivity (S) of the US was 83.33% and the specificity (E) was 94.07%.

    Conclusion: A decrease of the renal pelvic APD between US before and after surgery appears to be enough to exclude those patients who will not to develop a recurrence of ureteropelvic junction obstruction (UPJO). In the rest of the patients, it would be necessary study the urinary drainage using MAG3, avoiding its inherent drawbacks in all patients undergoing pyeloplasty.

  • Article
    Jesús Emmanuel Rosas Nava, Juan Eduardo Sánchez Núñez, Mario Téllez Sánchez, Eduardo Alberto González Bonilla, Adrián André Ramírez Beltrán, Miguel Maldonado Ávila, Hugo Armando Manzanilla García, Mateo Leopoldo Garduño Arteaga, Jorge Jaspersen Gastélum, Karolina Anabelle Borja Menéndez, Duval Alejandro Borja Menéndez
    Archivos Españoles de Urología. 2022, 75(6): 539-543. https://doi.org/10.56434/j.arch.esp.urol.20227506.79
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    Objective: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery.

    Methodology: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico “Dr. Eduardo Liceaga”. They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05).

    Results: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding.

    Conclusions: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients.

  • Article
    Cristina García-Sánchez, Inmaculada García-Obrero, Rafael Barrero-Candau, Juan Braulio García-Ramos, Antonio Javier Rodríguez-Pérez, Rafael Antonio Medina-López
    Archivos Españoles de Urología. 2022, 75(6): 544-551. https://doi.org/10.56434/j.arch.esp.urol.20227506.80
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    Introduction and Objectives: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information.

    Material and Method: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life.

    Results: We found no differences in continence rate between groups after the intervention. We found differences in “emotional problems” and “personal relationships”, in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas “energy/fatigue” and “social function” of the SF-36.

    Conclusions: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life.

  • Article
    Seyit Ahmet ERTÜRK, İsmail ŞALK, Birsen YÜCEL, Özge ULAŞ BABACAN, Zekiye HASBEK
    Archivos Españoles de Urología. 2022, 75(6): 552-558. https://doi.org/10.37554/en-j.arch.esp.urol-20210903-3536-35
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    Objectives: ALP and LDH are serum markers of prognostic importance in prostate cancer patients. PET/CT imaging with Ga-68 PSMA has played an important role in prostate cancer imaging in recent years. Our aim in this study was to evaluate the relationship and prognostic significance between SUVmax values obtained with Ga-68 PSMA PET/CT and LDH and ALP levels in prostate cancer patients.

    Methods: We retrospectively evaluated 61 prostate cancer patients who had Ga-68 PSMA PET/CT imaging and who did not have a prostatectomy between 2019 and 2020. PSA, ALP and LDH levels were measured in all patients before or after imaging within a maximum of 28 days.

    Results: The median age of the patients included in this study was 73 (range: 57–89) and all 61 patients were prostatic adenocarcinoma. 50 (82%) of the patients had distant metastasis in Ga-68 PSMA PET/CT. There was a significant positive correlation between serum LDH and PSA levels. There was a positive correlation between serum ALP and PSA levels. A negative correlation was found between ALP levels and prostate SUVmax.

    Conclusions: While negative correlation was found between SUVmax and ALP levels, no correlation was found between LDH levels and SUVmax. High ALP levels were found to be related to metastasis rates and severity and high serum PSA levels.

  • Article
    María Desamparados Cuenca Ramírez, Luz María Moratalla Charcos, José Agustín López González, Nidia Gómez Diez, Jorge Planelles Gómez, Juan Francisco Vidal Moreno
    Archivos Españoles de Urología. 2022, 75(6): 559-566. https://doi.org/10.56434/j.arch.esp.urol.20227506.82
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    Introduction: SARS-CoV2 pandemic has altered the normal activity in our day-to-day life. During the most critical moments of the pandemic at the hospital, attendance and programmed activities had to be reduced to a minimum, including kidney transplants. Hospitals with this kind of activity had to suspend or restructure it due to the decrease in the number of donors with a solid organ donation profile, the lack of knowledge as to whether the disease could be transmitted through transplantation or the risk that was believed to be associated with the admission of patients with end-stage chronic kidney disease or immunosuppressive treatment.

    Methods: A retrospective review of all patients who had received a kidney transplant at Doctor Peset University Hospital in Valencia was performed from March 2020 to March 2021. The objective was to study the safety of kidney transplantation and the incidence of COVID-19 disease in kidney transplant patients during this pandemic period.

    Results: 56 cases of kidney transplantation were included, most of them male with an average age of 56 years old, and variable comorbidity such as hypertension, dyslipidemia, an average body mass index of 26 and undergoing renal replacement therapy by hemodialysis. Regarding the organ donors, more than 50% were male patients and the donation was in encephalic death. The average cold ischemia time was 15 hours. Postoperative complications were mostly graded I and II in the Clavien-Dindo classification. 5.4% of the recipients had passed the SARS-CoV2 infection prior to the transplant and 5.4% were infected with COVID-19 after the transplant.

    Conclusion: In our experience, the current kidney transplant program seems viable and safe, even during periods of health emergencies.

  • Case Report
    Jorge Panach-Navarrete, Elsa Martínez-Montava, Rocío Gil-Viana, Lorena Valls-González, José María Martínez-Jabaloyas
    Archivos Españoles de Urología. 2022, 75(6): 567-571. https://doi.org/10.37554/es-j.arch.esp.urol-20210119-3532-31
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    Introduction: We show the ability of early ultrasound after surgery to show the success of endoscopic puncture of the ureterocele. Method: Description of the clinical cases, therapeutic management and description of the ultrasound findings.

    Results: We present two infants aged 1 and 4 months who underwent endoscopic puncture of ectopic ureteroceles during a period of 3 months at our institution. The first case was operated urgently for urinary sepsis, while the second was punctured to preserve renal function. In both cases, ultrasound was performed two hours after surgery, and the ultrasound findings were recorded. In both patients, the ureterocele was considered resolved one year after the puncture.

    Conclusions: Findings such as puncture notch, flap-like collapse of the walls, decrease in ureterohydronephrosis, or disappearance of debris in the upper tract, are ultrasound signs that are visualized in the immediate postoperative period of endoscopic puncture of the ureterocele. Thus, early ultrasound is useful for early monitoring of endoscopic treatment of ureterocele.

  • Case Report
    Ana Ruano Mayo, María Bedate Núñez, Consuelo Conde Redondo, Francisco María Lara Pérez, Pablo Panadero Meseguer, Jesús Calleja Escudero
    Archivos Españoles de Urología. 2022, 75(6): 572-575. https://doi.org/10.56434/j.arch.esp.urol.20227506.84
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    Introduction and Objective: The penile metastasis is a rare clinical entity. The objective is to present the first documented case report of penile metastasis from right colon.

    Clinical Case: A case of a 78-year-old man who was diagnosed with penile metastasis from right colon. The patient came to our consultation complaining of colic pain in the kidney and swelling of the penile which finally result in a malignant priapism. The diagnosis was histopathologic and was treated with chemotherapy and died few months later.

    Conclusion: Metastatic lesions in the penile are extremely rare; only 300 cases have been reported in the literature. It is a sign of bad prognosis. The mechanism of metastatic spread to the penis is not well established. Even there are several treatment options, is usually paliative.

  • Case Report
    Duval Alejandro Borja Menéndez, Karolina Anabelle Borja Menéndez, Andrea Catalina Parra Rosero, Mayra Consuelo Molina Herrera
    Archivos Españoles de Urología. 2022, 75(6): 576-579. https://doi.org/10.56434/j.arch.esp.urol.20227506.85
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    Objective: To report the treatment and clinical monitoring in patients with prostatic evanescent carcinoma at Hospital Carlos Andrade Marin.

    Methods: We reviewed the medical records of 148 patients undergoing by robot-assisted radical prostatectomy in Carlos Andrade Marin hospital. The cases reported between January 2016 to December 2018. The diagnosis was carried by taking a transrectal prostate biopsy with 12 cylinders. This samples are studied by the pathologist who reviews the radical prostatectomy surgery.

    Results: Three patients had prostatic evanescent carcinoma, which those cases showed Gleason 6 (3+3) prostate cancer. Two received neoadjuvant hormone therapy and the other patient presented minor tumor invasion in 1 out of 12 cylinders used during the biopsy. In the three cases, after the sample analysis, there was no residual tumor evidence. Therefore, they were classified as pT10.

    Conclusions: In this study, the results obtained from the patients studied presents the incidence of prostatic evanescent carcinoma is 2%. The combination of these different factors such as clinical status, preoperative PSA, number of positive cylinders and the invasion percentage, additionally to the usage of neoadjuvant hormone therapy prior the radical prostatectomy can help to predict evanescent carcinoma of the prostate.

  • Case Report
    Alejandro Mellado Castillero, Enrique Gómez Gómez, Juan Pablo Campos Hernández, Rafael Prieto Castro
    Archivos Españoles de Urología. 2022, 75(6): 580-583. https://doi.org/10.56434/j.arch.esp.urol.20227506.86
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    Objective: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature.

    Methods: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic.

    Results: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain.

    Conclusions: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect.