Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo

Introduction

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules.

Neurólisis robótica del pudendo en el tratamiento del síndrome de atrapamiento del pudendo

Introduction

Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country.

Factores pronósticos del tratamiento endoscópico del reflujo vesicoureteral en pacientes con lesión medular

IntroductionVesicoureteral reflux (VUR) is an important complication in patients with spinal cord injury due to its frequency and morbidity. One of the most extended therapeutic options is endoscopic injection of obliteration substances in the urethral meatus.ObjectiveTo analyze the prognostic factors of VUR treatment using obliterative substances in patients with spinal cord injury.Material and methodsA prospective study was performed in a cohort of 76 patients (age 48.9 ± 14.4 years), of both genders, with spinal cord injuries, who underwent endoscopic treatment of the VUR during the years 2008 to 2011. In all the patients, a clinical history was obtained and a pre-operative videourodynamic study was performed. Another study was carried out at 7.32 months (standard deviation: 6.28 months) of the intervention. Treatment consisted in endoscopic injection of dextranomer/hyaluronic acid copolymer (62 cases) and polydimethylsiloxane (14). The statistical tests applied were the Fisher's exact test and the Student's T test comparing the means. Bilateral significance level was established at 95%.ResultsResolution of VUR was achieved in 46 cases (61%). The statistically significant prognostic factors were age (younger aging cured patients), bilaterality and reflects great (greater grade in bilaterality in the cases with persistence of reflux) and presence of neurogenic detrusor overactivity (greater percentage in the cases of reflux persistence). Stress urinary incontinence (greater percentage in cured patients), contractile potency (lower percentage in cured patients) and urethral resistance (greater percentage in cured patients) were also statistically significant prognostic factors.ConclusionsAmong the prognostic factors that affected the endoscopic treatment results of the VUR in patients with neurogenic lower urinary tract dysfunction (NLUTD), anatomical as well as functional factors were found.     

Evaluación del virus del papiloma humano en varones: primera revisión exhaustiva de la literatura

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man.     

Factores pronósticos del resultado del tratamiento rehabilitador en la incontinencia urinaria femenina

BackgroundUrinary incontinence is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Numerous risk factors are associated with this entity. Rehabilitative treatment is established as the first line, although its use has not been protocolized.AimTo identify which personal risk factors and type of treatment applied are statistically related to patient improvement.MethodsRetrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital of Valladolid, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks, evaluating improvement or not according to 7 objective and subjective variables, establishing improvement as positive evolution in at least 5 of the 7.ResultsA total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement with a p > 0.05. The most used rehabilitative treatment was kinesitherapy + biofeedback (51%), which showed a statistically significant relationship with the improvement of these patients (p = 0.037), together with biofeedback + posterior tibial nerve electrostimulation (p = 0.044).ConclusionThe results are in line with other published studies. Biofeedback together with kinesitherapy or posterior tibial nerve electrostimulation are established as the most effective rehabilitative procedures.     

Factores implicados en el fracaso tardío del tratamiento endoscópico del reflujo vesicoureteral

Introduction

The short-term results of endoscopic treatment of vesicoureteral reflux (VUR) are excellent. Over time, however, a number of patients have been identified for whom VUR reappeared after being resolved with this technique. The aim of this study was to analyse the factors related to this event.

Ablación del cáncer renal por radiofrecuencia

IntroductionThe standard treatment of small renal masses is partial nephrectomy, which has showed similar oncologic results when compared with radical nephrectomy. Recently, ablative techniques, including radiofrequency and cryotherapy ablation, has been developed, with the purpose of minimizing adverse effects of standard surgical excision. In this article we review the technique of radiofrequency ablation.Material and methodsFor this review we conducted a search in the Medline database using the terms “renal radiofrequency ablation”.ResultsThe different currently marketed systems for the delivery of radiofrequency energy are examined. The different techniques of delivery (open, laparoscopic and percutaneous) are described; we observe a trend towards the use of the percutaneous method. Among the published clinical studies there are series of patients with midterm follow-up (3 years) that show oncologic outcomes similar to traditional resection techniques, with fewer complications.ConclusionsRenal tumor radiofrequency ablation has proved an effective therapy with minimal complications. However, it should be used only in selected patients until longer follow-up studies are available.     

Ablación del cáncer renal por radiofrecuencia

IntroductionStandard treatment for small renal masses is partial nephrectomy, which has shown oncological results similar to radical nephrectomy. Ablation procedures such as radiofrequency and cryotherapy have recently been developed in order to minimize the side effects of conventional surgical excision. This article reviews radiofrequency ablation.Materials and methodsFor this review, a search was made in the Medline database using the term “renal radiofrequency ablation”.ResultsThe different currently marketed systems for delivery of radiofrequency energy are examined. The different delivery approaches (open, laparoscopic, and percutaneous) are described. A trend towards use of the percutaneous approach was seen. Published clinical studies already include patient series with mid-term follow-ups (3 years) showing oncological outcomes similar to conventional resection procedures with fewer complications.ConclusionsRenal tumor radiofrequency ablation has proved to be an effective treatment with minimal complications. However, it should only be used in selected patients until longer follow-up studies are available.     

Bloqueo del plano del músculo erector espinal: estudio anatómico-cadavérico para determinar su mecanismo de acción

Introduction

The erector spinae plane (ESP) block is a novel technique for the treatment of acute and chronic pain. Its mechanism and site of action has not yet been explained properly.

Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática

Background

Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH.

Linfografía y embolización del conducto torácico como tratamiento del quilotórax tras esofagectomía por cáncer de esófago

IntroductionChylothorax is a rare complication in esophagectomies that is associated with increased postoperative mortality. Several factors have been described that may favor its appearance. Its treatment is controversial, and lymphography with percutaneous embolization of the thoracic duct is used by several groups.Material and methodOur retrospective study included patients who underwent esophagectomy for cancer of the esophagus or the esophagogastric junction (Siewert I/II) between January 2010 and April 2019 and developed chylothorax as a complication. Epidemiological data, type of surgery, morbidity and treatment were analyzed.Results274 cancer-related esophagectomies were performed in the study period. Thirteen patients (4.7%) were diagnosed with chylothorax in the postoperative period; 3 were resolved with conservative treatment. In the remaining 10 patients, lymphography was performed with aspiration of the cisterna chyli and thoracic duct embolization, which resolved the chylothorax in 9. One patient (10%) presented a biliary fístula after the procedure.ConclusionsLymphography with aspiration of the cisterna chyli and thoracic duct embolization is a technique with low morbidity that provides good results for the resolution of chylothorax after esophagectomy.     

Resección robótica del lóbulo hepático caudado: descripción técnica y consideraciones iniciales

Introduction

Firstly described in 2002, the robotic liver surgery has not spread widely due to its high cost and the lack of a standardized training program. Still being considered as a ‘development in progress’ technique, it has however a potential to overcome the traditional limitations of the laparoscopic approach in liver interventions.

Nefrectomía laparoscópica derecha de donante vivo: evaluación del resultado y asociación del IMC con la longitud de la vena renal derecha

AimsThe aim of this study was to describe outcomes of laparoscopic living donor right nephrectomy (LLDRN) and study factors affecting the length of right renal vein from the donors.Material and methodsThis study was conducted in 60 donors (48 males and 12 females) from January 2016 to December 2017. We performed a retrospective review of consecutive patients who underwent transperitoneal right laparoscopic living donor nephrectomy at our unit.ResultsLLDRN was successfully performed in all subjects by the same surgeons. Among 60 cases, 47 donors had single renal artery and vein, 2 cases had one artery and 2 veins, and 5 donors had 2 arteries and one vein, and the rest had 2-3 arteries with 1-3 veins. Operative time was 142.60 ± 33.73 min. Warm ischemic time was 2.64 ± 0.76 min. The mean hospital stay was 6.69 ± 0.63 days. The median length of right renal vein was 1.92 ± 0.41 cm. All transplanted kidneys showed immediate function. No graft losses were recorded. Almost no gender differences were found in study variables except BMI and warm ischemic time, that was higher BMI but shorter warm ischemic time in female versus male donors. Further analysis showed a negative correlation between BMI and right renal vein (r = −0.282, P < 0.05), but a positive correlation between operative time and estimate blood loss (r = 0.37, P < 0.01).ConclusionsLLDRN is a feasible safe procedure, less traumatic approach, and provides good outcomes kidney for recipients. Notably, in the study group the higher BMI was associated with resulting more difficult LLDRN and kidney transplantation.