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Biomedical subjects

R Vela Navarrete

Publications and source records attributed to R Vela Navarrete.

At least 19 recordsLinked to original sources
PubMed2006

[Synchronous bilateral urothelial carcinoma of the upper urinary tract].

OBJECTIVE: Report a case of a synchronous bilateral urothelial carcinoma of the upper urinary tract without bladder affectation. METHODS: We describe the diagnosis and treatment of a case of a bilateral upper urothelial carcinoma. CONCLUSIONS: Synchronous bilateral urithelial carcinoma of the upper urinary tract without bladder affectation in an unusual occurance (1-5% of urothelial tumors) and radical surgery continues to be the treatment of choice, although it is possible to take a less aggressive approuch with selected groups of patient, in which we can achiese a survival rate similar to that which we obtain with radical surgery.

Aged↗
PubMed2005

[Erectile dysfunction: the role of laboratory in the diagnostic and pronostic evaluation].

OBJECTIVE: To review and to update the different laboratory tests recommended for etiologic diagnostic of erectile dysfunction and to evaluate the effect these tests could have on the pronostic and therapeutic strategy of this pathology. MATERIAL AND METHODS: We review the last articles related with etiopathogenics and pathophysiologics mechanisms of erectile dysfunction, including our studies on endothelial dysfunction and erectile dysfunction. RESULTS: The depth and extension of the laboratory protocol in erectile dysfunction is not necessaryly the same in all situations. The age, coincidence of comorbilities, set a different limit between patients demanding complementaries investigations that go beyond the basic request. CONCLUSIONS: The etiopathogenic laboratory work up in erectile dysfunction is currently changing incorporating news tests. The traditional search of commorbilities like diabetes, hepatic dysfunction, hypogonadism, hyperglucemia is getting broad with recents analitics evaluations related with potential markers of endothelial disease.

Clinical Laboratory Techniques↗
PubMed2005

Ethical aspects of sexual medicine.

INTRODUCTION: Ethics describe the ways in which moral life is understood. Morality comprises norms for human conduct, and addresses what is right and what is wrong. AIM: To provide a consensus-based summary of the ethical aspects of sexual medicine. METHODS: Over 200 multidisciplinary specialists from 60 countries were divided into 17 consultation committees as part of a process organized by an international consultation on sexual medicine held in Paris, June 28-July 1, 2003 in close alliance with several sexual medicine organizations. Embarking on a study on ethics in sexual medicine, 10 experts from eight countries assembled over a two-year period to develop this consensus-based summary. MAIN OUTCOME MEASURE: Although ethics are recognized as subjective, expert opinion was based on grading of evidence-based medical literature, in addition to cultural and ethical considerations. The process also involved extensive internal committee discussion, public presentation, and debate. RESULTS: Contemporary medical practitioners provide health care for patients from many different cultures from all around the world. Thus, it is recommended that all health professionals working in sexual medicine should above all be able to demonstrate respect, understanding, and tolerance toward the differing moral worldviews of their patients and colleagues, and the societies they represent. In sexual medicine, health professionals have an obligation to respect the autonomy of any individual that they treat, regardless of that individual's religious or socio-cultural tradition, race, gender, or sexual orientation. Sexual rights are a necessary condition for sexual health. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. CONCLUSIONS: Additional discussion and research on ethics in sexual medicine is needed.

Cultural Diversity↗
PubMed2003

[Acute and immediate urination syndrome after transurethral resection: a case of incrustating cystopathy].

The authors present a case of acute and prompt symptomatic irritative urinary cystitis after transurethral resection (TR) of bladder cancer. The clinical presentation, like a irritative syndrome, was with a positive urine cultive to Enterococci and Staphylococcus. The physical examination, under general anesthesia (EBA), eliminated the urethral injury or the meatus trauma, so the urethral stenosis. The bladder view, in scaring processing yet, was congestive, bledding and edematous; an extensive white calcification was covering all the mucose surface bladder. The presumptive diagnosis was incrusted cystophatie (cystitis) and a transurethral resection (TR), along total bladder mucosa, was made so the result of pathological examination was sure. Intravenous and oral antimicrobial agent (Amoxicillin-Clavunan), in different ways, was instaured like a treatment, to achieve a negative urinary cultive, to eradicate the bacterial agents. We made a revision of the most important aspects in the clinical presentation, laboratory diagnosis and therapy, in this cystophatie that is not frequent, where the ureolitic bacterial agents have the responsibility, main Corynebacterium urealiticum, and where the recent urologic surgery or instrumentation, is narrowly related with the development of this cystophatie.

Acute Disease↗
PubMed2003

[Categorization of adrenergic alpha 1 receptors in detrusor of patients with obstructive BPH. Initial study on experimental animal model].

INTRODUCTION: The action of alpha 1-adrenergic receptor antagonists in ameliorating irritation and obstruction in patients with bladder outlet obstruction (due to Benign Prostatic Hyperplasia-BPH) has been demonstrated. Although it is well known that alpha 1-a receptors are responsible for prostate smooth muscle relaxation, the mechanism by which irritative bladder symptoms are improved is unknown. Different alpha 1 receptor subtypes may be involved. The objective of this study is to investigate the changes in the alpha-adrenergic receptor populations in the obstructed detrusor, and to determine which subtype is proportionally increased in this situation (bladder outlet obstruction). MATERIAL AND METHODS: This was an in vivo study in an experimental model: male NZ (New Zealand) rabbits. The bladder neck of one group of rabbits was obstructed surgically using the technique proposed by Levin et al. Subsequent to bladder catherization with a 8Fr catheter, the bladder neck was exposed by means of a low medial abdominal incision. The bladder neck was tied with a 2/0 silk thread below the ureteral orifices. The catheter was taken out at the end of the intervention. The rabbits were sacrificed after 4 weeks using intracardiac pentothal and cystectomy was performed. A control group that did not undergo bladder obstruction were also sacrificed at this time, for the comparative study. Part of the detrusor was used for a pathological study and the rest for a physio-pharmacological study in which the organ was placed in a bath of adrenoceptor agonists (phenylephrine and noradrenaline) and antagonists WB101, AH11101A and BMY7378 (antagonists of the alpha 1a, b, d, respectively). RESULTS: The findings of the pathological study show that the bladder wall was thicker in the rabbits that underwent bladder obstruction. The physio-pharmacological studies demonstrate that the detrusor response to the selective alpha-1 adrenergic agonist was greater in the rabbits that underwent bladder obstruction, however detrusor contractility was decreased (KPSS). With bladder obstruction the alpha 1d receptors were increased. DISCUSSION AND CONCLUSIONS: Receptor-binding studies (Malloy et al) aim to differentiate the alpha-adrenoreceptor populations. These studies identify and quantitate the different receptor subtypes in tissue without taking into account their activity. The isometric and physio-pharmacological tests evaluate active receptors, i.e. those that respond to agonist and antagonist stimuli. This enables detrusor activity to be evaluated accurately. The results obtained in this investigational study support the hypothesis that there is a high statistically significant increase in the alpha 1 adrenergic receptors in the obstructed detrusor. Furthermore, in agreement with previous molecular studies, during prostate obstruction alpha 1d is the predominate sub-population in the bladder. These findings may have patho-physiological, clinical and pharmacological implications. If this hypothesis which has been demonstrated in an experimental model, is also demonstrated in studies in humans, pharmacological development should not only be focussed on selective alpha 1a receptor antagonists (prostate) but also on those of alpha 1d, for relieving symptoms in patients with bladder outlet obstruction (BPH and prostatism).

Animals↗
PubMed2003

BPH and inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay.

INTRODUCTION: The role of infiltrating cells (I.C.), commonly observed in the adenoma interstitial tissue, is unknown. We tested the hypothesis that I.C. are related with BPH progression by: phenotypically characterising these cells; quantifying the expression of lymphokines and growth factors; investigating the response to Permixon (P) in a clinical study. Permixon is a lipido sterolic extract of Serenoa repens possessing pharmacological activities and widely used in the treatment of men with BPH. MATERIAL AND METHODS: A multicenter open pilot study of two parallel groups on BPH patients was carried out. They were randomized to receive either oral Permixon (P) 160 mg bid for three months or to be followed for 3 weeks without any treatment before surgery (control group C). Strict inclusion and exclusion criteria were applied to conform homogeneous groups, avoiding interferences of inflammatory drugs or others. Baseline clinical profile was almost identical in both groups in terms of age (65.7+/-5.1 vs. 67.1+/-5.8 years), IPSS (19.8+/-6.1 vs. 19.0+/-5.8), prostate volume (64.8+/-18.9 vs. 71.5+/-29.3cc), Q(max) (9.6+/-3.2 vs. 10.6+/-2.6 ml/s), and Q(L) (4.0+/-1.1 vs. 3.5+/-0.7). Surgery was ultimately performed on 29 patients (17C, 12P) by TURP or retropubic adenomectomy. Adenoma samples were routinely stained with HE and later prepared for immunohistochemical studies using CD3, CD20 and CD68 antibodies. Counting of positives cells, lymphoid aggregates and foci were done using EnVision technique and the Tech Mate processor. Cytokines, growth factors and eicosanoids were determined by Elisa kits following the manufactured recommendation. RESULTS: HISTOLOGICAL: A difference was observed in the number of lymphocytes B between C (91.4+/-44.1) and P treated (58.2+/-53.7) groups (p=0.097). BIOLOGICAL MARKERS: TNFalpha and IL-1beta were dramatically lower in the Permixon treated group. Other parameters did not show significant changes. CLINICAL: IPSS in the Permixon treated group was significantly reduced (p<0.006) from 20.0+5.9 to 14.9+3.8 after three months of treatment. COMMENTS: The BPH inflammatory hypothesis was tested in humans. Our pilot study shows a significant reduction of some inflammatory parameters in prostatic tissues of patients treated with Permixon. These biological findings justify a pharmacological effect of this drug on the inflammatory status of the adenoma. A correlation with clinical improvement was observed.

Adenoma↗
PubMed2002

[Benign prostatic hyperplasia: biological significance of lymphohistiocytic infiltration of the adenoma].

The presence of mononuclear cells infiltrating the prostate adenoma is a morphological observation well established in the literature. However, its biological meaning is a subject of controversy. It has been postulated that it may represent a local immunological reaction contributing to the pathogenesis of prostatic adenoma. Several studies have been performed to test this hypothesis, both in humans and animals. The purpose of this review is to update available information, including our own ongoing studies. Morphological research has shown that cells infiltrating the adenoma are lymphocyte T, lymphocyte B and macrophages with a high proportion of lymphocyte T. Many of the inflammatory markers, such as lymphoquines (IL1, IL2, IL4, IL6, IL13), are elevated in the adenoma tissue as are some growth factors (EGF, TGF alpha, IFN gamma, TGF beta). The general impression is that an inflammatory process is activated in the adenoma during growth and maturing. It has also been proved that this inflammatory process could be modified with treatment and, in our case, with the lipido-sterolic extract of Serenoa Repens.

Humans↗
PubMed2002

[Giant cyst of the seminal vesicle associated with ipsilateral renal agenesis].

Cyst of the seminal vesicles represent a rare but illustrative type of embryologic malformation whose etiology is associated with an abnormal development of the mesonephric or Wolffian duct. Frequently these malformations are associated with an abnormal development of the ipsilateral upper urinary tract. The initial evaluation of the majority of cases is performed with abdominal or transrectal ultrasound. Considering the possible need of other diagnostic procedures to confirm the diagnosis, ultrasonography is safe in the majority of cases. The treatment of these urologic malformations should be restricted to symptomatic cases and usually consists of vesiculectomy, with of without, removal of the displastic or histoplastic kidney. We present a case of a right mesonephric duct malformation with a giant seminal vesicle associated with ipsilateral kidney agenesis and severe oligozoospermia, that presented with sporadic episodes of hemospermia and urinary complaints.

Adult↗
PubMed2002

[Bellini's duct carcinoma].

Two new cases of uncommon Bellini's duct carcinoma are described. The existing literature is reviewed, discussing the clinical manifestations, diagnosis, treatment and embryological aspects, which differentiate from clear cell carcinoma.

Aged↗
PubMed2002

Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH often presents as lower urinary tract symptoms (LUTS) due to difficulties in voiding and irritability of the bladder. We conducted a retrospective cohort study within the Integrated Primary Care Information (IPCI) database, a general practitioners database in The Netherlands, to assess the incidence of LUTS suggestive of BPH (LUTS/BPH) in the general population. MATERIALS: Our study population comprised all males, 45 years or older who were registered for at least 6 months prior to start of follow-up. The study period lasted from 1 January 1995 to 31 December 2000. Cases of LUTS/BPH were defined as persons with a diagnosis of BPH, treatment or surgery for BPH, or urinary symptoms suggestive of BPH that could not be explained by other co-morbidity. RESULTS: The study cohort comprised 80,774 males who contributed 141,035 person-years of follow-up. We identified 2181 incident and 5605 prevalent LUTS/BPH cases. The overall incidence rate of LUTS/BPH was 15 per 1000 man-years (95% CI: 14.8-16.1). The incidence increased linearly (r(2) = 0.99) with age from three cases per 1000 man-years at the age of 45-49 years (95% CI: 2.4-3.6) to a maximum of 38 cases per 1000 man-years at the age of 75-79 years (95% CI: 34.1-42.9). After the age of 80 years, the incidence rate remained constant. For a symptom-free man of 46 years, the risk to develop LUTS/BPH over the coming 30 years, if he survives, is 45%. The overall prevalence of LUTS/BPH was 10.3% (95% CI: 10.2-10.5). The prevalence rate was lowest among males 45-49 years of age (2.7%) and increased with age until a maximum at the age of 80 years (24%). CONCLUSIONS: The incidence rate of LUTS/BPH increases linearly with age and reaches its maximum at the age of 79 years.

Age Distribution↗
PubMed2001

[The future of urology in Europe: a perspective from the European Urology Association].

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSIONS: An action plan is proposed to confront these changes without losing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

Europe↗
PubMed2001

[Surgery of renoureteral lithiasis. Current indications].

INTRODUCTION: Today, the issue about kidney and ureteral stone and their management is based on ESWL (Extracorporeal Shock Wave Lithotripsy) like singly or as a part of combination therapy. In some cases, endoscopic procedures (URS, PNL) with contact lithotripsy, is the first-line treatment. Retroperitoneoscopic is a therapeutical option in some hospitals. Open stone surgery is now drastically reducing and the endoscopic and extracorporeal methods are increasing, overcoat ESWL in those hospitals who has an own lithotripter. The optimal results of non-invasive procedures, and the ESWL advantages for the patients (outpatient and anesthesia-free treatment, decreased morbidity,...), has caused limited annual indications of open surgery for stone disease even a complete disappearance in many center. MATERIALS AND METHODS: The Stone and Lithotripsy Unit of "Jiménez Díaz" Foundation (FJD) (Madrid), who has an own lithotipter (Modulith SL 20, STORZ) make an evaluation of 54 patients treated with open surgery (1990-2000) in order to reflect on the indications. Nephrectomy for serious paremquimal lithiasic lesions (complicated pyelonefhritis, xantogranulomatosis....) is not included. RESULTS: The open surgery techniques for stone diseases were the classic according to every case: pielolithotomy (simple or extended +/- infundibulolithotomy), anatrophic nephrotomy, ureterolithotomy,.... At the same time it should be resolved those anomalous structures or obstruction associated to the stone disease (congenital hydroneprosis, ureterocele,...). DISCUSSION: Now days are difficult cases of stone diseases to be managed for any methods included open surgery. It's the renal complex stone. Of course, surgery is the best option, the more effectively choice. When endoscopic procedures (URS, NPL) fall and the stone is synthomatic must be operated. When they are serious situation (septic shock, complications derived from the others methods,...). It's necessary an urgent and effectively treatment and it's the open surgery. CONCLUSION: Open surgery is actually indicated for the complex renal stone and the complicated ureteral stone. So, the training on open surgery should be at the same time on the endoscopic, laparoscopic or extracorporeal. Open surgery will be the first-line treatment in some case. Open surgery should be considered in those urgent situation and will be done with skill and precision.

Adult↗
PubMed2001

The future of urology in Europe: an overview from the European association of urology.

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSION: An action plan is proposed to confront these changes without loosing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

Europe↗
PubMed2001

[Treatment of ureteral lithiasis with shock waves].

OBJECTIVE: To present our results with ESWL in situ in the treatment of ureteral lithiasis. Distal ureter calculi can be managed by ESWL or URS. For complex ureteral calculi associated with ureteral malformations, failed ESWL or complications other procedures are utilized (URS) and open surgery has its indications. METHODS: From October 1990 to December 2000 the Lithiasis-Lithotripsy Unit of the FJD has performed 2,500 ESWL in situ for ureteral calculi without endoscopic or percutaneous procedures (double-J or PN). The calculus was located in the lumbar ureter in 45%, sacro-iliac in 11% and renal pelvis in 44%. 67% were males and 33% females (mean age 48 and 42 years, respectively). Stone size was 5-20 mm in 88% of the cases; 1.5% had bilateral involvement, 1.7% multiple and 1.5% had a solitary kidney. 15% had renal colic when the procedure was performed. IVP was performed during ESWL for ureteral uric acid stones. RESULTS: The overall success rate was 95%; 97% for stones in the lumbar ureter and 89% for stones in the distal ureter. Repeat-ESWL rate was 1.10. Renal colic resolved during ESWL, although stone fragmentation was partial. Hematuria is common post-ESWL and irritative voiding symptoms on passage of stone fragments. Post-ESWL colic was observed in 20% of the cases but were managed without difficulty with medication. There were 3 cases of severe complications (0.12%), colon perforation, severe renal hematoma and peritonitis. Septic obstruction was found in 1.5% that required catheterization or nephrostomy. Radiologic and asymptomatic Steinstrasse was observed in 10% of the cases. CONCLUSIONS: ESWL in situ is the treatment of choice in ureteral lithiasis and has been demonstrated by many groups. The size and degree of stone impaction have a negative influence on the results. Resistance to fragmentation, which is basically determined by stone chemical composition, influence the results. Monohydrate calcium oxalate stones have been found to be the most resistant. Previous insertion of a catheter (double-J or nephrostomy) does not enhance the results. It appears to be useful during an episode of renal colic. Distal ureteral calculi can be treated by ESWL and URS. If a lithotriptor is available, ESWL without endoscopic procedures is the first choice.

Adolescent↗
PubMed2001

[Radiotransparent lithiasis. Diagnosis and treatment].

OBJECTIVE: To analyze current clinical, diagnostic and therapeutic aspects of uric acid lithiasis. The role of helical CT in its diagnosis, ESWL and alkalinization in its treatment, and metabolic and crystalographic analyses are discussed. METHODS: The incidence of uric acid calculi is estimated to be from 5% to 7% in the Lithiasis-Lithotripsy Unit of the Jiménez Díaz Foundation. The diagnostic and therapeutic possibilities of helical CT and ESWL are illustrated in a case of complex bilateral renal uric acid staghorn stone. RESULTS: Ultrasound and endoscopic uroradiology are fundamental in the diagnosis of radiotransparent obstructive bilateral renal stone. Ureteral catheterization was warranted due to the anuresis that resulted from bilateral obstructive renal failure. Stone dissolution combined with ESWL achieved rapid resolution of the large calculi. CONCLUSIONS: Helical CT without contrast enhancement should be performed along with the conventional urological diagnostic tests for ureteral lithiasis, especially in patients with renal colic. Although urinary alkalinization is the conventional treatment for uric acid stones, ESWL permits faster resolution in large, obstructive or ureteral stones in patients with renal colic. Complete assessment of patients with uric acid calculi includes metabolic and crystalographic analyses.

Aged↗