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H Villavicencio Mavrich

Publications and source records attributed to H Villavicencio Mavrich.

At least 19 recordsLinked to original sources
PubMed2006

[Da Vinci advanced robotic laparoscopic surgery: origin and current clinical application in urology, and comparison with open and laparoscopic surgery].

Over the last decade, open surgery, which is able to perform large extirpations and repairs of fragile tissues, is gradually being substituted with laparoscopic surgery due to the high benefits the latter entails for the patients, an also due to the learning difficulties for surgeons who must make up for such deficiencies applying higher efforts and a larger amount of stress. Robotic surgery stands in for the limitations of conventional laparoscopic surgery by means of performing more ergonomic and more accurate surgeries, particularly in the case of the most complex and difficult to access operations, such as radical prostatectomy. This review will perform a reminder of the history and clinical applications of new advanced and robotic technologies, and also a comparison with open surgery and conventional laparoscopy.

Equipment Design↗
PubMed2006

[Hormone-refractory prostate cancer. Modifications of the therapeutic strategies since chemotherapy proved its usefulness].

Back in the 90's it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice.

Androgen Antagonists↗
PubMed2006

[Rupture of the superficial dorsal vein of the penis].

Rupture of the superficial dorsal vein of the penis during intercourse is an unfrequented entity that makes the differential diagnosis with other acute penile injuries that may require surgical exploration necessary. We report the case of a 58-year-old male patient with 24-hours evolution painless haematoma after intercourse; its evolution and characteristic physical exploration enable us to adopt a conservative approach that resulted in complete recovery without sequels.

Humans↗
PubMed2006

[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.

Colic↗
PubMed2006

[Transperitoneal laparoscopic partial nephrectomy in the renal tumor treatment].

Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, where upon a conservative attitude was adopted.

Adult↗
PubMed2006

[Prognostic factor and prediction tables for clinically localized prostate cancer].

INTRODUCTION AND OBJECTIVES: To identify the independent prognostic factors of prostate cancer and to develop a table for predicting the probabilities of not-localised prostate cancer occurrence, thus permitting to restrict the radical prostatectomy indication to those patients who have greater probabilities of being cured by the procedure. METHODS: 1293 patients with clinically localised prostate cancer, with histories of neither hormone therapy nor prostate radiation therapy, in whom radical prostatectomy was performed during the period 1990-2003, were retrospectively evaluated. In order to analyse the prognostic factors, logistic regression was carried out by studying all the potential confusion and interaction factors, and by introducing the independent variables in a forward fashion with the following criteria: BCON(0.0001) LCON(0.00001) ITER(50) POUT(0.1). The prognostic variables were categorised, and the prediction table of the not-localised prostate cancer probability was developed from them. RESULTS: Clinical stage, prostatic specific antigen and Gleason's "grade" were identified as prognostic factors, taking into account that the higher they are, the higher the probability of not-localised prostate cancer occurrence. Logistic regression enabled us to develop a table to predict the probability of not-localised prostate cancer in which, taking a 50% probability as the cutoff point, a 26.13% sensitivity and a 94.65% specificity are obtained. The pathological examination of the prostate and the lymphadenectomy showed that, globally, 70% of the tumours were localised. CONCLUSIONS: Application of tables to predicting the probability of having not-localised prostate cancer offers the possibility of improving the prognostic accuracy of the so-called "risk groups", and enables to issue a therapeutic indication better adjusted to the actual status of the disease.

Adult↗
PubMed2005

[Percutaneous treatment with BCG in multiple upper tract transitional cell carcinoma].

Upper tract transitional cell carcinoma is a low prevalent tumour and frequently associated to bladder carcinoma. The antegrade endoscopic access represents a safe, efficient and minimally invasive access. The association to immunotherapy seems effective in decreasing recurrence. We present one patient with multiple upper tract carcinoma treated with percutaneous surgery and BCG.

Adjuvants, Immunologic↗
PubMed2000

[Intracranial metastasis in prostatic cancer].

The intracranial metastasis due to prostatic adenocarcinoma are quite rare, inside them, the ones placed in the parasellar region on the cranial base are exceptional. There are only 3 clinical cases found in the literature consulted, now we report here two more cases and we review the etiopathogenia, clinic presentation, diagnosis and treatment for this type of lesions. Usually there are very undifferentiated neoplasms, developed stages and with multiple metastasis at others levels. A patient with prostatic carcinoma known and neurological signs we should suspect the presence of intracranial metastasis. The diagnosis is made with image tests (basically with CT and MRI), being necessary in some cases the histological confirmation with a biopsy. Although the prognostic of these patients (less than 6 months in our cases) depends more of the evolutive stage of the illness than the type of treatment that the patients will be someated, we should establish it rapidly, on this way we can revert the neurological status and we will improve the quality of life of these patients.

Adenocarcinoma↗
PubMed1999

[The use of desmopressin as an alternative in the treatment of nycturia in patients with benign prostatic hyperplasia (BPH)].

OBJECTIVE: Evaluating in patients with benign prostatic hyperplasia (BPH), the effects of a synthetic analog of vasopressin (Desmopressin) in the nycturia. METHODS: 20 patients with BPH, with a mean age of 68 years that they referred marked nycturia of 4 to 10 voiding episodes in the night, they were subject treatment with Desmopressin 20 mcg given intranasally before bedtime. RESULTS: The nycturia diminishes in the patient, the volume of evacuated urine diminishes but in the night that in the day. They were not observed side effects. CONCLUSIONS: The desmopressin is an alternative but in the aid to the patient with BPH that they presented a marked nycturia.

Aged↗
PubMed1998

Incidence of tumoural pathology in horseshoe kidneys.

OBJECTIVES: To know the incidence of tumoural pathology among our cases of horseshoe kidney (HK), a congenital anomaly occurring in 0.25% of the population, as well as their prognostic factors and follow-up. METHODS: A total of 82 patients admitted at our Centre between 1967 and 1996 with an HK diagnosis were retrospectively reviewed. We have collected a total of 10 cases of HK tumours. We analyse the clinical, diagnostic, surgical and evolutionary peculiarities of the different HK tumour aetiologies, as compared with those described in literature. RESULTS: Our experience is based on 10 patients-5 adenocarcinomas, 4 transitional cell carcinomas and a Wilms' tumour. CONCLUSIONS: We have observed that in the case of transitional cell carcinomas, the diagnosis is generally made at an advanced stage. The prognosis of the tumorous disease depends upon the same prognostic factors as in the case of normal kidneys. Renal adenocarcinoma is the kind of tumour most frequently associated with HKs. Its incidence among the HK cases is not greater than among the normal population. Conservative local treatment criteria for adenocarcinoma should be valid for HKs as well.

Adenocarcinoma↗
PubMed1998

[Lumbar ureteral fistula after aortobifemoral bypass in a patient with ileal conduit and pelvic irradiation].

Contribution of a complex case of lumbar ureteral fistula with secondary abscess after aortobifemoral bypass in a patient with a background of radical cystectomy with ileal conduit and pelvic radiotherapy. A nephrostomy was established and the retroperitoneal collection was drained so that in a second phase ureteral replacement with ileum could be performed using uretero-ileal terminoterminal and ileum-ileal terminolateral by-pass with good therapeutic and functional results.

Aged↗
PubMed1998

Experience with lyophilized human dura mater for urethral strictures.

PURPOSE: We report our results using lyophilized human dura mater for urethral strictures. MATERIALS AND METHODS: The results of 131 urethroplasties using lyophilized human dura mater grafts were reviewed. The etiology of the stricture was unknown in most cases and 44.3% had not been previously treated. Mean stricture length was 10 cm. A dura mater patch was used in 124 cases and tubular graft in 7. RESULTS: Average followup was 56.6 months. The overall complication rate during the first month was 16.3%. At 6 months the graft failed in 2 cases and 25.2% had stricture recurrence. Good results were obtained in the longer term in 41.1% of cases, with a high recurrence rate and malignancy in 4 cases (3.2%) which required penectomy. CONCLUSIONS: Despite being a biologically well tolerated material, lyophilized human dura mater is not good for urethral strictures because of the high number of relapses and possibility of malignancy.

Dura Mater↗
PubMed1997

[Orthotopic bladder replacement: I. Physiopathology of orthotopic bladder replacement with intestine].

OBJECTIVE: To analyze the physiopathological principles of utilizing the bowel for orthotopic bladder substitution and their effects on metabolism, function and continence. METHODS: The world literature is reviewed and our experience of 100 cases is described in the third part of this study. RESULTS/CONCLUSION: To reduce the metabolic changes, utilization of colonic or ileal segments with a maximum length of about 40 cm is advocated. This length of detubulized intestinal segment permits creating an ample, low pressure reservoir with an antireflux mechanism. The precise incidence of neoplastic degeneration of the ileal and colonic reservoirs is not known, but appears to be lower for the ileal neobladder.

Humans↗
PubMed1997

[Orthotopic bladder substitution: II. Types and complications].

OBJECTIVE: In the last two decades, attention has been focused on the design of continent urinary diversion and orthotopic neobladder in an attempt to find the ideal bladder substitute. The more commonly utilized techniques of orthotopic bladder replacement are described and the urodynamic aspects and complications are analyzed. METHODS: The series of Studer, Hautmann, Kock, Pagano, Thuroff (Mainz Pouch) and Goldwasser and the relevant literature on this subject were reviewed. RESULTS/CONCLUSION: To date, similar functional results have been achieved by the different techniques of bladder substitution, although different intestinal segments are utilized. A longer follow-up is warranted to determine which is the ideal technique of bladder substitution.

Cecum↗
PubMed1997

[Orthotopic bladder replacement: II. Functional results and complications in patients with Studer-type ileal neobladder].

OBJECTIVE: Since 1988, 100 Studer ileal low pressure urinary reservoirs have been performed at our institution. The functional results and the complications observed in these patients are presented. METHODS: Patients submitted to radical cystectomy and lower urinary tract reconstruction with the Studer technique from 1988 to 1994 were retrospectively studied. All patients were males, their mean age was 60 years (37-75) and the mean follow-up was 18 months (6-72). The isoperistaltic ileal segment as antireflux mechanism was utilized in 97 cases and intussusception of the ileal segment to which the ureters were anastomosed in 3 cases. Reinsertion of the ureter was done using the Wallace technique in 90 cases and by direct fixation according to a personal technique (H.V.) in 10 cases. Anastomosis of the neobladder and the urethra was done with the end of the second suture of the orthotopic reservoir. The neurovascular bands were preserved in 21 patients less than 60 years old with tumor stage T2-T3a, according to the technique described by Walsh and Mostwin (1984). RESULTS: One patient died early postoperatively from sepsis. The early complications included urinoma (4%), urinary fistula (3%), intestinal fistula (2%), pulmonary complications (4%), pelvic hematoma (1%) and intestinal obstruction (3%). Only 4 of these patients required surgical resolution of the complication. The late complications included stricture of neobladder-urethra anastomosis (6%), lithiasis in neobladder (4%), ureteroileal stricture (8%), 5 renal units were lost, chronic urinary retention (5%), symptomatic metabolic acidosis (1%) and urinary infection (14%). Thirteen of these patients with late complications required surgery. At 6 months' minimum follow-up, 90% of the patients were continent during the day and 60% during the night. Overall, 36% of the patients recovered erection postoperatively; 76% of the patients with preserved neurovascular bands recovered erection. Forty-four percent of the patients claimed they had a satisfactory sexual activity postoperatively. CONCLUSION: The Studer neobladder permits voiding through the urethra, preservation of the upper urinary tract, the urinary infection rate is acceptable, the complication rate is low and it offers patients continence rates that allow them to have a good quality of life.

Adult↗