Biomedical subjects

M Esteban Fuertes

Publications and source records attributed to M Esteban Fuertes.

At least 37 records · Page 2Linked to original sources

PubMed1996

[Usefulness of the neuroandrologic profile study in patients with erectile dysfunction: review of a series of 180 cases].

OBJECTIVES: To determine the usefulness of a complete neuroandrologic evaluation and SPACE (Single Potential Analysis Cavernous Electromyography) in the study of impotence. METHODS: We performed a clinical study, erection test with papaverine-phentolamine and neuroandrologic evaluation (bulbocavernous EMG, S2-S4 evoked potentials, evoked somatosensorial potentials, SPACE, D10-L2 skin sympathetic potentials, cystometrogram, and filling videocystography) in 180 patients consulting for impotence. RESULTS: We observed a relationship between the clinical diagnosis of impotence and the data from the neuroandrogenic study. The results of the study were classified as normal [in the clinical diagnosis of psychogenic impotence (100%), hormonal (80%) and vascular (60%)], abnormal [prevalent in the clinical diagnosis of structural impotence (87%)]. The erection test was mainly negative in all clinical diagnoses of impotence, except in psychogenic and vascular impotence (60% positive tests). CONCLUSIONS: The clinical data are useful in the diagnosis of impotence. The pharmacological erection test was not found to be very reliable. Complete neuroandrologic evaluation is indicated in non typified and mixed impotence, and can be performed in neurogenic impotence to identify the level of the lesion. Alone, SPACE does not appear to be useful as a screening test for neurologic lesions, but can be useful as a screening test for neuromuscular cavernous lesions. SPACE is indicated in structural, vascular and hormonal impotence. If SPACE is abnormal, the differential diagnosis between neurogenic and myogenic lesion can be made through a complete neuroandrologic evaluation.

Adult↗

PubMed1996

[The need for an adequate urodynamic study in the assessment of stress urinary incontinence following urethropexis].

OBJECTIVES: To determine the utility of the urethral pressure profile and videocystography in the evaluation of stress urinary incontinence posturethropexy. METHODS: A clinical, urodynamic and radiological study was conducted in 50 females who had undergone urethropexy due to stress urinary incontinence. The clinical features and urodynamic demonstration of urinary incontinence were analyzed and the type of incontinence was evaluated by videocystography and the urethral pressure profile posturethropexy. RESULTS: The urethral pressures did not correlate with the clinical findings or urodynamic demonstration of urinary incontinence posturethropexy. A maximum urethral pressure significantly lower in patients with radiologically demonstrated type III incontinence was observed. The presence of an open bladder neck, although significantly more frequent in patients with type III urinary incontinence, showed no correlation with the demonstration of urinary incontinence. An open bladder neck was also observed in patients with type II incontinence and patients who were continent posturethropexy. CONCLUSIONS: To determine the type of urinary incontinence posturethropexy, it is necessary to utilize cystomanometry, filling videocystography and urethral pressure profile.

Adult↗

PubMed1995

[Effects of urethropexy on urination. A price to pay?].

OBJECTIVES: To evaluate the voiding repercussions of urethropexy. METHODS: We carried out a clinical and urodynamic study in 70 patients subjected to different techniques of urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch and simplified Ramirez) for stress urinary incontinence. We evaluated the voiding repercussions of urethropexy. RESULTS: There was a significant increase in the obstructive symptoms with urethropexy (29% of the patients) although there was no relationship with the variation of the urinary flow rate. It also significantly diminished the urinary flow rate (85% of the patients) and increased the postvoiding volume significantly (3.68 times the average before surgery). The increase in postvoiding volume occurred more frequently in patients with diminished urinary flow rate before urethropexy (60% of the cases). The Raz technique showed less urodynamic data of voiding disturbances. CONCLUSIONS: Urethropexy causes voiding disturbance. We believe the decrease in urinary flow rate is related to the increase in urethral resistance produced by urethropexy. In the cases with previously diminished urinary flow rate, reduction in bladder contractility is added to the former mechanism.

Adult↗

PubMed1995

[Clinical, urodynamic, and radiologic results in the study of prostatism with the PURR measure (passive urethral resistance ratio)].

OBJECTIVE: The present study was conducted to determine the correlation between the urinary symptoms and lower urinary tract dynamics in patients with prostatism. METHODS: 105 males with prostatism (mean 66.19 years) were evaluated clinically, urodynamically and radiologically by PURR (passive urethral resistance ratio) determination. RESULTS: The intensity of the irritative symptoms was slightly higher (21%) when bladder instability was associated. The obstructive symptoms were associated with diminished urinary flow rate and could be observed in bladder outlet obstruction (81%) or diminished bladder contractility (79%). Both conditions were found in 49% of the cases. The postvoiding urine depended on diminished bladder contractility (37%), but not on bladder outlet obstruction. Bladder instability did not depend on obstruction, although 88% of the patients with unstable bladder were obstructed. Compressive obstruction was associated with a lesser degree of diminished contractility (55%) than the other forms of obstruction. Prostatism was associated with diminished contractility without bladder outlet obstruction in 15% of the cases. The irregular bladder was more frequent in bladder outlet obstruction (92%) and bladder diverticula were more frequent in bladder instability (36%). In all the cases with compression and lengthening of the prostatic urethra, the diagnosis was compressive obstruction. In all the cases with segmental, diminished urethral diameter, the diagnosis was obstruction, although only 30% were diagnosed as constrictive compression. No pathological urethral changes were demonstrable on cystourethrography in 33% of the cases with obstruction. CONCLUSIONS: Urinary symptoms correlate poorly with lower urinary tract dynamics. PURR determination is a very reliable method of diagnosis in urinary obstruction, for both segmentally diminished and more extensive involvement (elongation and compression of the prostatic urethra) of the urethral lumen.

Adult↗

PubMed1995

[A comparative study of different urodynamic methods used in the diagnosis of lower urinary tract obstruction in men].

OBJECTIVES: The present study compared the results of the different urodynamic methods utilized in the diagnosis of urinary obstruction. METHODS: A urodynamic study was performed in 105 patients with prostatism; mean age 66.19 years. The following five urodynamic methods were utilized: maximum pressure/maximum flow rate (Pmax/Fmax), pressure/flow nomogram, pressure/flow curve, Schaefer's PURR and the resistance square. RESULTS: The Pmax/Fmax method showed the lowest percentage of obstruction (61%), 48% of the nomograms were inconclusive, the pressure/flow curve diagnosed obstruction in 88%, Schaefer's PURR diagnosed obstruction in 77% and the resistance square diagnosed obstruction in 78% of the cases. When the nomogram findings were diagnostic, no significant differences between the other methods were observed. The Pmax/Fmax, pressure/flow curve and the PURR methods proved to be independent methods, while the resistance square showed no significant differences with Schaefer's PURR. An irregular bladder at cystography was associated with a significantly higher percentage of obstruction (72% vs 92%). Lengthening and compression of the prostatic urethra demonstrable on cystourethrography was associated with the diagnosis of obstruction on all the methods used. A diminished segment of the urethral lumen was associated with a high percentage of obstruction on all methods, the PURR showing the highest (100%). However, the diagnosis of constrictive obstruction was found in only 30% of the cases.

Adult↗

PubMed1995

[Renal metastasis from breast carcinoma: a new case and review of the literature].

OBJECTIVES: Breast carcinoma is the most common malignant tumor in the female. A vast majority of the cases present metastasis at the time of diagnosis. A case of breast carcinoma metastatic to the kidney is described to emphasize that in the presence of a renal mass, a secondary or metastatic tumor should be suspected. The literature is briefly reviewed. METHODS: We report on the diagnosis and treatment of an expanding left renal mass in a female patient with a previous history of multiorgan tumors (ovarian, breast and small bowel) or different histological types that had been diagnosed and treated at different periods. RESULTS: Following radical nephrectomy, analysis of the surgical specimen disclosed a metastatic tumor from breast carcinoma. No subsequent treatment was required and the patient is well 6 months postoperatively. CONCLUSIONS: Metastasis from a primary tumor must be suspected in patients with a previous history of tumor presenting with a renal mass. Renal metastasis presents in the advanced stages of tumor dissemination. Treatment depends on patient general condition and the stage of the primary and metastatic tumors.

Breast Neoplasms↗

PubMed1995

[Surgical treatment of male hypospadias with pediculated transversal preputial flap technique: a 10-year follow-up].

OBJECTIVES: The study was conducted to evaluate the long-term follow-up micturition data, sexual function and cosmetic results of hypospadias surgical repair. METHODS: 14 males (mean age 19.6 yrs) submitted to hypospadias surgical repair with the pedicled preputial tubulized flap technique 10 years ago were evaluated. RESULTS: The most frequent site of the anomaly was the distal third of penis (85.6%). The micturition data were excellent and urinary flow rates were normal in 92.8%. Erection and ejaculation were normal in all patients. Penile curvature persisted in 14.2%; 64.2% of the patients had sexual intercourse (completely satisfactory in 66.6%), penis size was normal in 78.6% and 66.6% of the patients were married and had children. No longterm follow-up complications were observed. CONCLUSIONS: The technique achieved excellent cosmetic and functional results.

Adolescent↗

PubMed1995

[Leiomyosarcoma within a bladder diverticulum].

Sarcomas are a rare entity among malignant tumours of the bladder. This paper presents the case of a male patient with leiomyosarcoma within a vesical diverticulum. The approach undertaken was diverticulectomy and, since the tumour was limited to the diverticulum and no metastatic disease was present, no other adjuvant therapy was considered.

Aged↗

PubMed1994

[Comparative results of different types of urethropexy in the treatment of stress urinary incontinence in women].

We conducted a clinical and urodynamic study in 70 patients who had undergone different urethropexy procedures for stress urinary incontinence. Urethropexy had achieved positive results in 87% of the patients. Incontinence persisted in 21% of the patients. Urethropexy significantly reduced the urge-incontinence and frequency associated with this disorder. Anterior urethropexy did not increase the incidence of poor results in the present series since no patient had intrinsic urethral involvement. The suprapubic and the combined techniques achieved the following cure rates: Marshall-Marchetti-Krantz (92%), Burch (100%), Ramírez simplified (80%), Raz (60%). The cure rate for the Kelly vaginal technique was found to be lower (57%).

Adult↗

PubMed1994

[Infantile enuresis: epidemiologic, clinical, urodynamic, and radiologic data of a consecutive series of 100 cases].

The present paper reports the epidemiological, clinical, urodynamic and cystographic data of 100 consecutive patients (mean age 9.59 years) with nocturnal enuresis. These patients were divided into three groups: group I (4 to 7 years old), 23 patients; group II (8 to 11 years old), 51 patients; and group III (12 to 14 years old), 26 patients. Nocturnal enuresis was more frequent in group II (51%). It was more prevalent in males (51%) of groups I and II. Isolated nocturnal enuresis was more frequent (54%) than nocturnal enuresis associated with diurnal symptoms (46%) in all age groups. Urinary infection was observed in 16% and was more prevalent in girls (68.7%). Detrusor instability was the most common urodynamic finding (40%), particularly in group II and girls. Uncoordinated voiding was the second most common urodynamic finding (24%), particularly in group II and girls. Lower urinary tract infection was observed in 1% (males). No abnormal urodynamic data were observed in 19%. Neurogenic bladder was observed in 16%, mainly in group II (31%). Vesicoureteral reflux was detected in 18%, mainly in girls (66.6%) and a postvoiding residual urine in 10%. A diagnostic and prognostic system and a therapeutic strategy based on our data are proposed.

Adolescent↗

PubMed1994

[Renal carcinoma with tumor embolism of the supradiaphragmatic inferior vena cava: therapeutic alternatives and review of the literature].

We report a case of a man with a left renal cancer and vena caval thrombus extending to the right atrium, that was not possible to remove because infiltration of the posterior plane was detected intraoperatively. The patient was rehospitalized for intractable haematuria. He underwent selective embolization of the left renal artery with ethanol and coil. There were no complications and the patient is well seven months after the procedure. We review the literature on the diagnostic and therapeutic options in such cases. We can conclude that it is necessary to know the exact stage of the primary cancer in order to choose the best treatment. MRI or dynamic CT should be utilized to determine the presence of infiltration of adjacent structures or distant metastasis. Radical nephrectomy and the removal of the caval thrombus afford the only possibility of survival in these patients.

Diagnosis, Differential↗

PubMed1994

[Diversions of the upper urinary tract] in oncologic patients].

Herein it is described the survival rate, the quality of life and the complications of the upper urinary tract diversion in 22 pluri-treated tumoral patients (both male and female, average 65.2 years old). Cancer etiology has been: colon-rectum neoplasia (36.3%), bladder carcinoma (36.3%), prostate carcinoma (9.9%), ovary cancer (4.5%), abdominal wall desmoid tumor (4.5%), pheochromocytoma (4.5%) and gastric carcinoma (4.5%). Urinary diversions type has been: percutaneous nephrostomy (40.9%), ureteral stent (31.8%), both (13.6%) and cutaneous ureterostomy (13.6%). Urinary diversions were performed unilateral in 90.9%. The average survival has been 4.8 months. The quality of life was poor in 68.1%. The following complications were observed: urinary infection (45.4%), hematuria (36.3%), diversion catheter lose (34.8%) and obstruction (27.2%). Urinary diversion in pluri-treated cancer patients must be carefully indicated to prevent negative aspects upon psychophysic and social activity of the patients.

Abdominal Neoplasms↗

PubMed1994

[Determination of serum SCC antigen in transitional cell carcinoma of the bladder].

The SCC antigen expresses in the squamous epithelium during the process of a neoplastic transformation. This paper's objective is to evaluate the biological behaviour of SCC antigen in surface, deep, localized and spread malignant vesical carcinoma. To this end, 100 patients divided in two groups were studied. The first group consisted in 30 healthy subjects strictly selected and the second group comprised 70 patients diagnosed with transitional cell vesical carcinoma. SCC Antigen measurement was made by Radioimmunoassay (RIA, Abbott). Our results suggest that this tumoral antigen has no use as a prognostic factor in patients diagnosed with transitional cells vesical carcinoma, since serum concentrations suffer no change in relation to size, extent and degree of tumoral differentiation.

Antigens, Neoplasm↗

PubMedDate not supplied

[The usefulness of vaginal cones as a method of measuring perineal muscle strength. The RECOVA Group. REeducación COnos VAginales].

OBJECTIVE: To determine the utility of vaginal cones for the measurement of perineal muscle strength. METHODS: A study was conducted on 134 women (mean age 31.8 years) to determine the correlation between a clinical test for measuring perineal muscle strength and the number of vaginal cones retained by the patients. RESULTS: A correlation was found between the clinical test for measuring perineal muscle strength and the number of vaginal cones retained in 90% of the cases. This correlation increased to 96% in patients that had undergone rehabilitation of the perineal muscles with vaginal cones for a period of three months. CONCLUSION: Our results show that vaginal cones permit objective measurement of perineal muscle strength.

Adult↗

PubMedDate not supplied

[The therapeutic efficacy of vaginal cones in rehabilitating the perineal musculature. The RECOVA Group. REeducación COnos VAginales].

OBJECTIVE: To determine the utility of vaginal cones in the rehabilitation of the perineal muscles. METHODS: A study was conducted on 134 women (mean age 31.8 years). The control group comprised 51 women (38%) and study the group comprised 85 patients (62%) undergoing rehabilitation of the perineal muscles with vaginal cones for a period of three months. Both groups were adjusted for statistical analysis. RESULTS: The patients undergoing rehabilitation retained a vaginal cone 1.3-2.4 times more than the controls. The dropout rate was 29%. The patients who abandoned the study showed significant differences in comparison to those who completed the treatment for age, length of perineal muscle less than 3 cm, belonging to the control group and were followed by nurses. CONCLUSIONS: Rehabilitation using vaginal cones significantly improves the strength of the perineal muscles.

Adult↗

PubMedDate not supplied

[Impact of bladder irritative symptoms and detrusor instability on the outcome of urethropexy].

OBJECTIVES: To evaluate the repercussion of irritative urinary symptoms and bladder instability on the results of urethropexy for urinary stress incontinence. METHODS: A clinical and urodynamic study was carried out in 70 adult women submitted to urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch or simplified Ramirez technique). RESULTS: The urge incontinence symptom was associated with coughing incontinence is 38 (60%) of the patients submitted to urethropexy. This symptom decreased to 42% (27 patients) after urethropexy. The average score of diurnal urinary frequency was 23% less posturethropexy. The simplified Ramirez technique had the lowest diurnal urinary frequency score [1.17 +/- 1.07 (0 to 3)]. Bladder instability with urinary stress incontinence (mixed incontinence) was found in 21 (30%) patients before urethropexy. The incidence of bladder instability after urethropexy was significantly greater in this group (52%) than in the patients with isolated urinary stress incontinence (17%). However, urethropexy also corrected bladder instability in 30% of the women with mixed incontinence. The Kelly technique produced the lowest incidence of bladder instability after urethropexy (14%). CONCLUSIONS: Urethropexy significantly decreases the irritative urinary symptoms associated with stress urinary incontinence. In some cases, bladder instability associated with stress incontinence (mixed incontinence) may disappear following urethropexy. In most cases bladder instability continues after urethropexy.

Adult↗

PubMedDate not supplied

[Urinary incontinence and bacteriuria in women].

We analyzed the urodynamic data and their relationship with significant bacteriuria in 103 consecutive female patients (mean age = 55.7 yrs) with urinary incontinence. Significant bacteriuria was observed in 25.2% of the cases. E. coli was the pathogen most frequently isolated (70.3%). Significant bacteriuria was demonstrated in 29.3% of the patients with urge-incontinence. The most frequent type of incontinence in patients with bacteriuria was no urodynamic reproduction of urinary incontinence (42.8%). Bladder instability was not associated with significant bacteriuria (27.2%). Significant bacteriuria was observed in 75% of the patients with lower urinary tract obstruction, 66.6% of the patients who voided by abdominal straining and 26.3% of those with postvoiding residual urine. These findings indicate that urine culture should be done in patients with no urodynamic reproduction of urinary incontinence. There was no statistically significant correlation between urge-incontinence/bladder instability and significant bacteriuria. Consequently, antibiotics should not be used routinely in female urinary incontinence.

Adolescent↗

PubMedDate not supplied

[Role of the bladder neck in urinary continence in women after urethropexy].

We conducted a clinical, radiological and urodynamic study in 70 patients submitted to different urethropexy techniques (Kelly, Raz, Marshall-Marchetti-Krantz, Burch, simplified Ramírez) to determine the importance of the bladder neck in the treatment of urinary incontinence. Urethropexy achieved a significant increase in the percentage of patients with an open bladder neck during the filling phase. However, the opening of the bladder neck posturethropexy did not influence urinary continence.

Adult↗