Biomedical subjects

J Cisneros Ledó

Publications and source records attributed to J Cisneros Ledó.

5 recordsLinked to original sources

PubMed1999

[Development of a clinical pathway for radical prostatectomy].

OBJECTIVE: To describe the clinical care path for retropubic radical prostatectomy of the La Paz teaching hospital and the results achieved after the first 6 months. METHODS: We have developed a clinical care path for radical prostatectomy with a hospital stay of 6 days. Thirty-one patients submitted to retropubic radical prostatectomy from June to November 1998 were included in the program. The mean length of total, preoperative and postoperative stay were analyzed and compared with those of 31 patients who had undergone radical prostatectomy before the program was developed. Readmissions, adverse effects and patient satisfaction were also analyzed. RESULTS: Of the 31 patients included in the clinical care path, 22 (71%) had a stay equal to or less than the program's length of stay. The mean total, pre and postoperative stay for the group of patients included in the clinical care path were 6.0 days (SD = 1.1), 1 day (SD = 0.0) and 4.9 days (SD = 1.1), respectively. The length of stay was significantly longer before the program was developed [mean total 10.2 days (SD = 4.9), mean preoperative 2.6 days (SD = 2.6) and mean postoperative 7.6 days (SD = 3.6)] (p < 0.001). Twenty-four patients (77.4%) completed the questionnaire on patient satisfaction, which was highly positive, the overall patient satisfaction rate being higher than the 90% standard. There were no readmissions or significant events ascribable to the program. CONCLUSIONS: In our experience, the clinical care path for radical prostatectomy is a useful tool to reduce the unwanted variability. Its design is based on the best possible evidence, therefore the scientific and technical quality, patient satisfaction and efficiency are enhanced. In our view, our results are attainable and feasible in any health care setting.

Critical Pathways↗

PubMed1996

[Endourologic complication: endourologic resolution].

OBJECTIVES: To report an uncommon endourological complication that was also resolved by endourological methods. METHODS/RESULTS: We report on a patient with a right solitary kidney, radiolucent renal stone and an indwelling double-J catheter. While removing the double-J catheter after ESWL, it broke at the level of its distal third. The proximal two thirds remaining in the ureter were successfully removed by ureteroscopy after several attempts by ureteroscopy and percutaneous nephroscopy. CONCLUSIONS: Except for special circumstances, most of the endourological complications can be resolved by an endourological procedure.

Equipment Failure↗

PubMed1995

[Technics of ureteral endoscopic access].

OBJECTIVES: The present article briefly reviews the history of endoscopic access to the ureter, since visualization of the ureter was first attempted until the procedure was developed by Pérez-Castro in 1979. METHODS/RESULTS: The development of the rigid ureteroscopes, the difficulties arising from the anatomical structures during endoscopy that require ureteral dilatation, the anatomy of the juxtavesical segment of the ureter and the pathologies that may alter it, and the present and future indications of ureteral dilatation are discussed. Patient preoperative evaluation is briefly described and one of the techniques of ureteral dilatation is analyzed. Finally, a brief summary comparing the different techniques is given. CONCLUSIONS: The technique of choice for ureteral dilatation must be simple, easy to perform, low-cost and one which reduces the iatrogenic lesions and shortens the duration of hospital stay.

Dilatation↗

PubMed1995

[Memotherm as a therapeutic device in infravesical obstruction].

OBJECTIVE: To determine the efficacy of the intraurethral mesh in the treatment of infravesical obstruction in patients at high surgical risk unamenable to other treatment modalities. METHODS: We evaluated 13 patients with obstruction and at high risk for conventional surgery (TURP) who underwent insertion of the Memotherm intraurethral prosthesis. RESULTS: The procedure was performed rapidly with scant morbidity and the patients were discharged from the hospital early. Improvement, evaluated by the IPSS-L, was referred by 84.6% of the patients at 45 weeks follow up. Post-treatment improvement was evidenced by the absence of postvoiding residual urine at ultrasound in 69.2% of the patients and improved flowmetry in 84.6% of the patients. The early post-treatment complications included hematuria with irritative symptoms (80% of the patients). The mesh prosthesis had migrated in 15%, but could be repositioned. No case required removal of the prosthesis. CONCLUSIONS: This method affords a rapid and atraumatic solution for obstructed patients at high surgical risk. The material (heat sensitive nitinol) and the design of the mesh facilitate repositioning in the few cases in whom this had been required.

Aged↗

PubMedDate not supplied

[Prognostic value of inverted papilloma of the lower urinary tract].

OBJECTIVE: Inverted papilloma of the urothelium accounts for 2.2% of urothelial neoplasms. Its oncologic significance is unclear; its potential for recurrence and/or progression is not well-known. Our experience from 1976 to 1999 is reviewed. METHODS: From 1976 to 1999, 31 patients with urothelial inverted papilloma of the lower urinary tract have been treated in our service: 17 presented previous and/or synchronous association with urothelial carcinoma (group I) and 14 had primary inverted papilloma (group II). The recurrence and progression rates for each group were determined and compared. The overall recurrence and progression rates were also determined. Two patients (one from each group) were lost to follow-up. The remaining 29 patients had a mean follow-up of 51.3 months (range 3-125). RESULTS: 12 patients (41.4%) showed recurrence in the form of bladder carcinoma; 10 from group I (10/16; 62.3%) and 2 from group II (2/13; 15.4%) (p < 0.05). Mean time to recurrence was 17.9 months (range 3-58). Disease free interval was higher in group II (p < 0.05). Progression to infiltrating tumor was observed in three patients; all three had associated superficial bladder carcinoma (group I). The mean time to progression was 30.7 months (range 18-38). No statistically significant differences were found in the percentage of progression between both groups. CONCLUSIONS: Inverted papilloma of the lower urinary tract showed a high incidence of association with urothelial carcinoma and a high recurrence rate, even in primary tumors. Therefore it should be considered a tumor of low grade malignancy that should be followed regularly.

Adult↗