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I Moncada Iribarren

Publications and source records attributed to I Moncada Iribarren.

At least 19 recordsLinked to original sources
PubMed2006

[Efficacy and safety of two dosing regimens with Tadalafil in Spanish men with erectile dysfunction: results from the SURE study in 14 European countries].

OBJECTIVE: [corrected] To compare the efficacy and safety of tadalafil 20 mg administered 3 times/week (SCH) vs. on demand (OD) in a cohort of Spanish men with erectile dysfunction (ED), since Tadalafil period of responsiveness lasts up to 36 hours post-dosing. MATERIAL AND METHODS: The 418 Spanish patients participating in the European multicenter, crossover, open-label SURE clinical trial (comprising 4262 men) were randomly assigned to one of the treatment sequences: tadalafil 20 mg SCH for 5-6 weeks followed by tadalafil 20 mg OD for 5-6 weeks, or the inverse sequence. At completion, patients were asked to select the regimen they preferred to receive in an extension phase. RESULTS: In both regimens, tadalafil led to a similar improvement in erectile function compared to baseline. However, the SCH regimen showed statistically significant higher scores for several IIEF questions (i.e. sexual desire domain). Normal erectile function (IIEF EF domain score > or = 26) was achieved by 69.3% of patients on SCH and 64.3 % on OD, with a sexual intercourse success rate (SEP3) of 75.6% and 72.2% respectively (p<0.05). Nevertheless, more patients preferred to receive tadalafil OD for the extension phase (55.9% vs 44.1%, p<0.05). Tadalafil was well tolerated in both regimens. The most common TEAEs (> or = 5%) were headache, dyspepsia and back pain. There were no clinically significant differences in the incidence of TEAEs between regimens. CONCLUSIONS: Tadalafil 20 mg is efficacious and well tolerated for the treatment of ED, regardless the regimen of administration (OD or SCH). Patients can choose the pattern of administration that fits better with their expectations.

Adult↗
PubMed2005

[Parameters with possible influence in PSA adjusted for transition zone volume].

OBJECTIVE: To evaluate the effect of age, digital rectal examination results and prostatic volume on PSA value adjusted to transition zone (PSA-TZ) in the detection of prostatic cancer. MATERIAL AND METHODS: Data of 243 patients with serum PSA of 4 to 20 ng/ml who underwent biopsy because of prostatic cancer suspicion are analyzed. In this population, cancer was detected in 62 cases (24.8%). Total prostatic volume and transition zone volume were calculated by transrectal echography applying the ellipsoid formula. RESULTS: Applying lineal regresion analysis, it was found no correlation between age and PSA-TZ (Pearson coefficient 0.00). By dividing these patients among those with normal rectal examination (84%) and those with suspicious digital rectal examination (16%), cutoff values of PSA-TZ were found to be not different by ROC curves analysis for 95% sensitivity varying specificity only among 24 and 26% between these two groups of patients. Prostatic size (< or = or >40 cc) showed that, for obtaining the same 95% sensitivity in the detection of cancer, PSA-TZ value would require to be modified, being 0.17 in large prostates (> 40 cc) and 0.25 in small prostates (< or =40 cc). CONCLUSIONS: The utility of PSA-TZ as a potential predictor parameter of prostatic cancer did not need to be modified with respect to age or to data of digital rectal examination. However, for supporting sensivity of its best cutoff value, PSA-TZ would need to be modified with respect to total prostatic volume.

Aged↗
PubMed2005

[Evaluation of prostate specific antigen (PSA) adjusted to transition zone in prostatic cancer detection].

OBJECTIVE: To investigate if PSA adjusted to transition zone (PSA-TZ) can be considered as a predictor parameter of cancer with better specificity or not than PSA, PSA density (PSAD) or PSA free/total ratio. MATERIAL AND METHODS: Data of 706 patients with sextant prostatic biopsies are analyzed in prospective way because of prostatic cancer suspicion. Range of PSA was between 4 to 20 ng/ml. Determination of PSA-TZ was calculated by dividing the PSA value by the volume of the transition zone of the prostate applying the ellipsoid formula and comparison of obtained results in detection of cancer was performed by ROC curves analysis for each one of PSA-related parameters. RESULTS: Of the total group of patients, in 199 cases (28.2%) prostatic cancer was detected. Analysis by ROC curves demonstrated than PSA-TZ and PSAD were better predictors of cancer than PSA free/total ratio and PSA (p < 0.0001). The cutoff value of PSA-TZ of 0.18 ng/ml/cc was considered as the best, obtaining a 95% sensitivity and a 27% specificity. For this sensitivity, PSA, PSAD and PSA free/total ratio only obtained 5, 9 and 16% specificity respectively. Areas under curve (AUC) obtained for PSA, PSA free/total ratio, PSAD and PSA-TZ were 0.539, 0.612, 0.694 and 0.722 respectively. CONCLUSIONS: PSA-TZ in the studied population was a parameter with better diagnostic specificity than PSA, PSAD and PSA free/total ratio for the same 95% sensitivity. This would justify its utility in clinical paractice reducing the number of unnecesary biopsies.

Aged↗
PubMed2004

[Treatment with Doxazosin in 3347 patients with lower urinary tract symptoms. Impact on sexual function. The impros study].

OBJECTIVES: An open, non-comparative, multicenter study was performed to ascertain the prevalence in Spain of erectile dysfunction (ED) associated to benign prostatic hypertrophy (BPH), with moderate to severe urinary symptoms, and to confirm the improvement or disappearance of ED in response to treatment with 4 mg/day of Doxazosin. METHODS: Out of the 3901 patients recruited 3545 took the medication and 3347 completed all the protocol visits. BPH patients were considered to have some degree of erectile dysfunction when they reported a difficulty for obtaining and/or maintaining an erection in the four weeks prior to their inclusion in the study (questions 3 and 4 of the International Index of Erectile Function). All the patients were treated with Doxazosin at increasing doses: from 1 mg/day up to 4 mg/day thereafter until 6 months of medication were completed. RESULTS: The mean number of patients showing erectile dysfunction was 69.1%, ranging from 48.3% in the 40-49 years age group to 76.3% in the group aged from 60 to 69 years. In most Spanish regions, the prevalence of ED ranged from 76.9% in Cantabria to 67.2% in Aragon. The mean number of patients in whom erectile dysfunction disappeared after treatment, with a 95% confidence interval, was 4.5%, ranging from 17.5% in the 40-49 age group to 1.1% in the over 70s. CONCLUSIONS: ED is a symptom very often associated to BPH, even in relatively young men. Doxazosin appears to have a beneficial effect in ED improvement, particularly in the younger patients.

Adrenergic alpha-Antagonists↗
PubMed2004

[Treatment with sildenafil of cold glands syndrome after inflatable penile prosthesis].

OBJECTIVE: To evaluate the effect of sildenafil on the response of glans penis during sexual intercourse in patients with penile prosthesis who show cold glans syndrome symptoms. MATERIAL AND METHODS: Fourteen patients who had undergone three-piece inflatable penile prosthesis implantation were evaluated. In spite of the normal functioning of the device all of them complained of a degree of dissatisfaction during SI due to a lack of engorgement in the glans penis. The patients were advised to have a dose of 100 mg VO sildenafil about 45 minutes before activating the PP and starting SI. All of them followed this scheme at least three times. They ticked questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire with/without having had sildenafil. RESULTS: Twelve out of thirteen patients (85.7%) indicated a more pleasant SI on sildenafil. It was related to an increase in penile glans engorgement and sensitivity. The scores obtained in the IIEF questions showed a significant increase on taking sildenafil. The partners also talked of a more comfortable SI that they related to a less painful penetration. Sildenafil-related morbidity was not found. CONCLUSIONS: Sildenafil could be used to improve functional results of the penile prosthesis in those patients with CGS and seems to increase satisfaction during SI.

Body Temperature↗
PubMed1999

Pharmacological treatment of erectile dysfunction.

There is growing evidence that the field of pharmacotherapy, particularly oral drugs, will be dominant in the future management of sexual dysfunction. Basic research has led to the understanding of the intracellular mechanisms that control penile smooth muscle contractility and therefore erection, opening a vast area for pharmacological intervention. Moreover, the importance of central neurohormonal mechanisms has made these pathways the target for new centrally acting drugs. Given these trends most patients suffering from erectile dysfunction will respond to pharmacological agents in the not so distant future.

Adrenergic alpha-Antagonists↗
PubMed1998

[Treatment of erectile dysfunction using intracavernous pharmacotherapy].

Intracavernous injection of vasodilators has been the greatest diagnostic and therapeutical breakthrough in erectile dysfunction (E.D.). After 15 years experience, these vasodilators have demonstrated efficacy rates over 85%. This suggests that most cases of E.D. are the result of and inability of the smooth muscle to relax. This paper presents an overview of the diagnostic and therapeutic use of intracavernous vasodilating drugs. It includes an extensive review of the literature and our personal series with regard to efficacy, indications, contraindications and side-effects of these compounds. Alprostadil i.c. injection (PGE1) is an effective (> 70%) and safe treatment, and its use has been accompanied by an increased quality of life of patients, with very few side effects. Currently, PGE1 is a first choice drug in the treatment of impotence. When no response is seen, or pain develops after PGE1 administration, a number of vasoactive compounds associations can be used instead (phentolamine + PGE1, papaverine + phentolamine, and papaverine + phentolamine + PGE1). The phentolamine + VIP association has shown encouraging results. Prior to prescribe IC treatment with vasoactive drugs it is necessary to conduct a basic diagnostic study, and advise the patient. If treatment is finally accepted, the performance of adequate training and detailed medical follow-up is crucial.

Contraindications↗
PubMed1997

[Complications of radical nephrectomy in the treatment of kidney adenocarcinoma].

PURPOSE: To evaluate the peri- and post-surgical complications in Renal Adenocarcinoma (RAC) treated with Radical Nephrectomy (RN). MATERIAL AND METHOD: Revision of 109 patients with RAC who underwent transperitoneal anterior abdominal RN. Patients were locally staged post-surgically as: T1 + T2 61.5%, T3a 22.9%, T3ab 11% and T3b 4.6%. Approach and conservation of homolateral suprarenal gland were decided based on the preferences of the performing urologist. Hilar lymphadenectomy was performed in all cases. RN was done by a staff member in 77% cases and by a training resident assisted by a staff member in the remaining 23%. RESULTS: Peri-operative complications occurred in 10% patients, most commonly with left RN (13% vs. 7%) (p = 0.1), and further within this group the most frequent ones occurred in those using midpoint laparotomy (17.8% vs. 4%) (p = 0.1). Blood transfusion during surgery was required in 23% patients, this being more frequent when tumours had extended into the venous system (47%) and in left RN by midpoint laparotomy (39% vs. 12.5%) (p = 0.02). There were 32 post-surgical complications in 27 (24.8%) patients, the most common being sepsis of the surgical wound (6.4%); complications were more usual in patients undergoing right RN (31% vs. 20%) (p = 0.08) and in patients with blood transfusions (40% vs. 20%) (p = 0.4). There were no deaths. CONCLUSIONS: In our series, RN showed low intraoperative morbidity (10%), non-insignificant post-operative morbidity (24.8%) and no mortality. We consider subcostal laparotomy to be the best surgical approach in left RAC, with low morbidity and low peri-operative blood requirements.

Adenocarcinoma↗
PubMed1997

[Ultrasonographic and pathologic differences between non-palpable prostate cancer (T1c) and palpable lesions detected with rectal examination].

OBJECTIVE: To determine whether non-palpable cancers (T1c) have different ultrasound and pathological features from other palpable cancers of the prostate gland. MATERIAL AND METHOD: PSA levels, ultrasound features and Gleason score in 178 patients diagnosed with prostate cancer between 1994-1995 were compared. Correlation of pathological findings in surgical sections from 47 patients undergoing radical prostatectomy. RESULTS: 22% tumours were non-palpable. No difference was observed between both age groups (p = 0.5) and PSA levels (p = 0.09). Differences were noted in favour of palpable cancer in PSAD (p = 0.01), incidence of ultrasound nodes (p < 0.001), capsule changes (p < 0.001), seminal vesicles (p < 0.001), Gleason score (p = 0.006) and bone scan (p < 0.05). Two (14%) patients with non-palpable cancer showed no tumour in the prostatectomy section. Apart from these 2 patients, no differences were found between both groups in terms of Gleason score (p = 0.3), local stage (p = 0.7) and node involvement (p = 0.4) in patients undergoing radical prostatectomy. CONCLUSIONS: 86% patients with non-palpable prostate cancer has clinically significant tumours and showed no differences from the rest of tumours undergoing radical prostatectomy.

Aged↗
PubMed1996

[Clinical and neuro-urodynamic assessment of radical prostatectomy].

OBJECTIVES: To study the clinical and urodynamic parameters after radical prostatectomy in order to standardize the management of these patients in the medium-term. METHODS: 35 cases submitted to radical prostatectomy from February, 1989 to March, 1994 were retrospectively evaluated clinically and urodynamically using a clinical questionnaire, free flowmetry, cystometry, pressure/flow voiding test with simultaneous videocystography and sacral-evoked potentials. The mean age was 65 years and mean follow-up was 14 months. RESULTS: 80% (28) were continent or minimally incontinent on exertion, 9% (3) required the use of some absorbent system and 11% (4) were completely incontinent and required the use of a collecting system. No statistical differences were observed between continence status and tumor stage, patient age or neurovascular preservation. Overall the urodynamic parameters fell within the normal ranges, except for a reduced maximum cystometric capacity. A significant difference (p = 0.05) was found in those patients with significant incontinence vs those who did not for maximum free flow, which disappeared on flowmetry with transducer catheter. Seventy per cent of the incontinent cases were evident on evaluation; 60% had stress incontinence and 40% had instability waves with differential pressure over 80 cm H2O. Six per cent met the criteria for obstruction, whose localization was done during videocystography. Eleven per cent showed non inhibited contractions and 6% showed diminished bladder compliance. The sacral reflex arch was normal in all patients. CONCLUSIONS: The urodynamic study was found to be normal in the majority of patients submitted to radical prostatectomy; therefore performing the study routinely is not justified. However, incontinent patients and those with disturbances on free flowmetry may show incontinence due to instability or obstruction of the urethrovesical junction. We therefore advocate performing a complete study on all patients with significant incontinence and free flowmetry for the rest at least three months after surgery and a complete study should be done if disturbances are found.

Aged↗
PubMed1996

[Multicentricity in renal adenocarcinoma: its incidence and the therapeutic implications].

Unsuspected multicentricity in single Renal Adenocarcinoma (RAC) together with the prospects of incomplete neoplasia removal are the 2 major disadvantages for the acceptance of traditional renal surgery in birenal carriers of medium size, low grade single RAC. This paper is a retrospective review of our series of RAC patients who underwent radical nephrectomy between January 1986 and October 1994 with the following purpose: 1) To evaluate our incidence of unsuspected multicentricity. 2) To evaluate the characteristics of such multicentricity. 3) To evaluate, in the assumption that traditional surgery had been indicated for patients with small size RAC, in how many patients tumoral resection would have been incomplete due to existence of satellite tumoral nodes in the preserved renal parenchyma. Of 110 patients undergoing radical nephrectomy, 11.8% (13/110) had unsuspected multicentricity. In 10 patients there was multiple satellite nodes with size ranging from 0.3 to 3 cm. We conclude that there is not relationship between multicentricity and size or stage of primary tumour and that, by applying strict criteria (size, location, well defined tumoral wall and form of presentation) to select the patients who can be candidates to traditional renal surgery, the probability to perform it in patients with multicentric RAC would be considerably reduced.

Adult↗
PubMed1996

[Comparative study of duplex Doppler ultrasonography and dynamic cavernosometry by infusion in the diagnosis of arteriogenic impotence].

The findings of duplex doppler ultrasonography (DDU) of cavernous arteries (CA) and of dynamic infusion cavernosometry in 61 patients who underwent both diagnostic procedures were examined. Our work consisted in comparing the blood flow velocity in the CAs during the systolic peak, as measured with DDU, with the gradient CA occlusion pressure/mean brachial blood pressure and in attempting to determine whether there was a correlation between both measurements and whether patients were similarly classified by both methods. The results of each examination separately were also compared with the response to isolated injection of intracavernous drugs (ICI). Of the 61 patients, 56 were eligible for the study as 5 patients were excluded owing to a massive venous leak. A 78.6% of the patients were categorized similarly by both diagnostic methods. The correlation coefficient between both methods for the 56 evaluable patients was R = -0.756, implying a statistically significant correlation between the two measurements (p < 0.0001). The sensitivity, specificity and predictive value of a positive test as regards the response to the ICI of vasoactive drugs in both diagnostic methods showed very similar values in our sample. We conclude that both methods--the Doppler Ultrasonography and the measurement of the occlusion pressure of the cavernous arteries--are equally valid for assessing the arterial function of the cavernous bodies in erection. If we consider that the erectile function of the penis consists in storing energy in the form of pressure and that this pressure is supplied by the cavernous arteries, from a physiological point of view, it is more consistent to measure the pressure in these arteries.

Adult↗
PubMed1996

[Endourologic treatment of ureteral ruptures in closed abdominal trauma].

The traumatic fracture of the ureter is a very uncommon entity, which accounts for 1-5% of all urological traumatism. In most cases it is secondary to penetrating lesions, endoscopic or open surgery iatrogeny, its occurrence as secondary to closed traumatism being very rare. The paper presents four patients with partial ureteral fractures caused by closed traumatism. Management was in all cases conservative with endourological methods, using backward ureteral intubation, and no case required the use of other types of complementary surgical approaches; functional recovery of urinary tract was complete in all four patients.

Adolescent↗
PubMed1995

[Malignant neoplasms in kidney transplant recipients].

OBJECTIVES: This study is a retrospective analysis of malignant tumors in renal transplant recipients. A review of the pertinent literature allowed us to develop a protocol for early diagnosis and treatment of tumors arising in this group of patients. METHOD: 171 renal transplants have been performed over a period of 4 years. The renal grafts had been harvested from cadavers (mean age 32.01 years). All recipients (mean age 44.3 years) were immunosuppressed with prednisone, azathioprine and cyclosporine A. RESULTS: Five "de novo" malignant tumors were detected in 4 patients (2.3%). The tumors were basal cell epithelioma of scalp and gastric adenocarcinoma in the same patient, lymphoma of the CNS, carcinoma of the breast and adenocarcinoma of the colon. The patient with a gastric adenocarcinoma died after a disease-free interval of 28 months, following treatment of the cutaneous lesion. The patient with lymphoma of the CNS had died before receiving treatment and the remaining 2 patients are disease-free at 12 and 6 months' follow-up. CONCLUSIONS: The possible role of viruses is underscored. Transplant recipients should be followed very closely since they are likely to develop a tumor, especially of skin and lips. The importance of gynecological and neurological assessment and control of native kidneys cannot be overemphasized. Performing an autopsy on donors can reduce the risk of transplanting tumors. Kidney transplantation should be delayed if the graft recipient has a tumor. Correct diagnosis and treatment will enhance the results in these patients.

Adolescent↗
PubMed1995

[Hemangioma of the adrenal gland].

Adrenal gland haemangioma is an uncommon tumour which finding usually occurs by chance. This paper presents one case of cavernous haemangioma in this location on which surgery was performed successfully. The basic aspects of the case are revised from a pathohistological and diagnostic point of view intended to attempt to suspect its presence preoperatively.

Adrenal Gland Neoplasms↗
PubMed1994

[Necrotizing vasculitis located exclusively in the bladder: report of a case].

Necrosing vasculitis and, within it, nodosa polyarteritis, is an infrequent entity characterized by the absence of pathognomonic signs and symptoms, but which can potentially affect the entire body. The initial description was made by Kussmaul and Maier in 1866. Sings and symptoms of this clinical picture are not frequently circumscribed to the urinary tract. We describe here one case of a particularly infrequent presentation, as a vesical mass with gross haematuria. The paper discusses the clinical picture, diagnosis and treatment of this process.

Humans↗
PubMed1994

[Obstructive uropathy in Gardner syndrome: a new case and an alternative therapeutic option].

Gardner's Syndrome comprises numerous pathological entities, one of which is the intraabdominal desmoid tumour which can provoke obstructive uropathy through ureteral trapping. Contribution of one case treated with resection of the trapped ureter, reanastomosis and plasty with peritoneal flap. Discussion of the diagnosis, evolution, and the different therapeutical choices found in the literature.

Adult↗