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The research of the origin anddevelopment of the Medical-surgical specialties in ourenvironment has been, to my knowledge, limited. Theaim of this work is to review it in reference to Urology,one of the first specialties developed in Mallorca duringthe second half of the XIX Century and the beginning ofthe XX century. Evidence acquisition has been performedthrough research of the archives of the Royal Academyof Medicine of the Balearic Islands (RAMIB) and theMedical College and the study of the Balearic Journal ofMedical sciences. Furthermore, the biographies of themain precursors and pioneers of Urology in Mallorcahave been reconstructed
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OBJECTIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy.METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p < 0.05% and a confidence interval (CI) of 95 %.RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8 % of patients treated with laser therapy had urinary irritative symptoms compared with 6.3 % in the endoscopic surgery group (p = 0.01).Within the laser group, 26.4 % of patients had urine leakage compared to 4.4 % among those operated by bipolar TUR (p = 0,03). 86.7 % of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6 % of the laser therapy cohort (p = 0.03).CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection.
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OBJECTIVES: To evaluate usefulness and morbidity of clean intermittent catheterization (CIC) using a decreasing pattern in patients with bladder voiding dysfunction (BVD) of varied etiology.METHODS: We performed a retrospective study of patients with BVD in whom CIC was indicated. We evaluated the clinical presentation, post-void residual urine (PVR), results of the urodynamic studies (UDS), and response to CIC in a decreasing pattern, complications and patient adherence. The primary endpoint was a favorable response to CIC in a decreasing frequency pattern. Secondary endpoints were complications and patient perception of it.RESULTS: We evaluated a total of 27 patients with BVD. Of these, 15 (56%) were women and 12 (44%) were men. Mean age was 54.33 years (32-82) and mean follow-up time was 23.5 months (2-66). The mean catheterized volume and the number of catheterizations decreased in all groups of patients. 40.7% of all patients did not need to perform catheterization after an average time of 7.38 months. The average time to reach a stable PVR or the lack of it was 9.76 months (0.75 to 63). The only complication recorded were urinary tract infection (UTI) presenting as mild cystitis in 7 patients and orchitis in 2 patients. 70.4% (19/27) responded to the telephone survey. 79% (15/19) said they have had no major difficulty in learning CIC, 52.7% (10/19) said to be continuing CIC, and the mean personal rating was 6/10.CONCLUSION: CIC in a decreasing pattern allows almost half of the patients to be totally free from catheterization. The other half reduces significantly the number of catheterizations, with little interference in their daily lives. It is an effective technique, well accepted and well learned by most patients with BVD in a wide range of indications, beyond neurogenic dysfunction.
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OBJECTIVES: Avanafil is a highly selective phosfosdiesterase 5 inhibitor (PDE5 inhibitor), with rapid onset of action, approved by the Food and Drug Administration (FDA) and the European Medicines Agency for the treatment of erectile dysfunction (ED). It had been recently commercialized in Spain. This article presents a detailed review of the available literature, where the safety, tolerability and efficacy of avanafil were evaluated.METHODS: A systematic literature search using the Medline database was performed. The search included the terms Avanafil and erectile dysfunction. The pivotal studies of clinical development of the drug, and also those randomized, double-blind, placebo-controlled, well-designed studies were analyzed. We included those studies published in English up to January 2014. Likewise, studies of the pharmacokinetics and pharmacodynamics of the drug were also included.RESULTS: The avanafil pivotal studies, conducted in general population of patients with ED, patients with Diabetes mellitus type I and II and patients with ED secondary to nerve sparing radical prostatectomy were analyzed. In all these studies, avanafil demonstrated a statistically significant improvement in erectile function /(IIEF), and all the coprimary outcomes (SEP2 and SEP3) compared to placebo. Also, a good tolerance profile and few side effects compared to placebo were evident.CONCLUSIONS: Avanafil is a selective PDE5 inhibitors, that is rapidly absorbed and that has a short time to peak response. It found to be effective in randomized, double-blind, placebo-controlled trials conducted in men with erectile dysfunction, including in patients with diabetes mellitus and after radical prostatectomy. It was generally well tolerated across trials, with very few patients withdrawing because of adverse effects. Similarly, avanafil had a significantly lower rate of hemodynamic side effects compared with sildenafil.
Case Report
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OBJECTIVE: To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery. METHODS: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn’t perform renal biopsy.RESULTS: Most renal masses are renal carcinomas (85%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosisCONCLUSIONS: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis.
Case Report
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OBJECTIVE: To report the case of a urethral tumour in a patient with mental deficiency.METHODS/ RESULTS: Complete resection of the tumour was performed and the pathologic examination informed the presence of urethral adenocarcinoma. The patient is disease-free twelve months after surgery.CONCLUSIONS: Bibliographic review for diagnosis and treatment was performed.
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OBJECTIVE: We report a case of nonfunctioning giant adrenal cortical carcinoma undergoing complete resection.METHODS: We report the case and evolution of a woman who underwent resection of a giant adrenal carcinoma at Santa Marcelina Hospital.RESULTS: A 49-year-old female presented with palpable mass in the right hypochondrium extending 5 cm down from the right costal margin. Abdominal CT Scan found a large mass occupying the right adrenal region with areas suggestive of necrosis, in close contact with the liver, pushing the right kidney inferiorly and extending to the midline. Biochemical tests to evaluate hormonal secretion resulted in levels within the normal range characteristic of a non-functioning adrenal neoplasm. The treatment of choice was resection of the abdominal mass; the surgical specimen greatest diameter was 21 cm and weighed 2106 grams. It was an adrenal cortical carcinoma.CONCLUSIONS: Options for the treatment of adrenal cortical carcinoma showed no significant advances in recent decades and complete surgical resection remains the most effective treatment for adrenal cortical carcinoma, even in patients with bulky tumor masses.
Editorial
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Editorial
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