Biomedical subjects

Vicente Chiva Robles

Publications and source records attributed to Vicente Chiva Robles.

9 recordsLinked to original sources

PubMed2006

[Laparoscopic pyelolithotomy].

The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option.

Humans↗

PubMed2006

[Post chemotherapy laparoscopic retroperitoneal lymph node dissection].

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty.

Adult↗

PubMed2005

[Penile prosthesis. Quality outcomes and morbidity].

OBJECTIVES: To study patient satisfaction and complications appeared in a series of patients with erectile dysfunction undergoing implant of penile prosthesis. METHODS: Retrospective study of all patients undergoing surgical treatment for erectile dysfunction by penile prosthesis implant between 1993 and 2003. Collected data included patient age at the time of surgery, previous treatment, and significant medical history. We reviewed the models of prosthesis employed, incisions, and complications appeared. Finally, a questionnaire was elaborated to establish the level of patient satisfaction. RESULTS: 24 prostheses were implanted between 1993 and 2003. Mean patient age was 56.6 +/- 7.56 years (36-63), median 59.5 yr. Penile-scrotal incision was employed in 13 (54.16%) patients, suprapubic incision in 6 (25%) and subcoronal incision in 1 (4.16%). Type of prosthesis: semirrigid AMS 600 9 (37.5%), semirrigid AMS 650 10 (41.66%); the two component hydraulic prosthesis AMS Ambicor was used only in one case. Six (25%) patients presented complications. 16.66% were minor, cavernositis, pain, hematoma or prosthesis extrusion. Prosthesis extraction was necessary in 2 (8.33%) cases. 13 (54.16%) patients responded to the telephone survey 85% of them use their prosthesis. 54% percent refer adequate self-satisfaction and partner satisfaction (well satisfied/much satisfaction). 23% not too bad, and the remainder 23% bad or very bad. CONCLUSIONS: Despite the highest rate of postoperative complications, penile prosthesis is adequately accepted by patients with erectile dysfunction, even malleable models. Patient satisfaction is high, being higher in partners. Most patients would desire to undergo surgery again if they were in the same situation.

Humans↗

PubMed2005

[Transperitoneal laparoscopic radical prostatectomy].

Summary.reaching widespread diffusion in the urological community but intensive training is necessary to achieve an optimal level of skill to perform them. We report the transperitoneal laparoscopic radical prostatectomy surgical technique step-by-step.

Humans↗

PubMed2005

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy].

OBJECTIVES: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. TECHNIQUE: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.

Adult↗

PubMed2004

[Preliminary results in a series of patients with prostate cancer who underwent radical prostatectomy].

OBJECTIVES: To analyze the preliminary results in our series of radical retropubic prostatectomies (RRP) in terms of complications; and to evaluate also its efficacy in disease control (cancer progression and survival). METHODS: We reviewed the charts of 139 patients who underwent radical prostatectomy. Preoperative data such as age at the time of diagnosis, serum PSA, presence of suspicious digital rectal examination (DRE), clinical stage, and Gleason's score on biopsy. Complications noted after RRP were studied. Survival analysis (Kaplan-Meier) was performed to study clinical and biochemical progression in relation to factors such as baseline PSA, pathologic Gleason's score, pathologic stage, affected surgical margins and capsular penetration. Univariate comparison of factors was performed using the log-rank test. Multivariate analysis (Cox model) was also carried out to identify predictive variables (or risk factors) for progression. RESULTS: 127 patients were available for progression assessment (91.4%). Overall, 19 complications were registered in the immediate postoperative period. 89 patients (91.8%) stated being continent in their last follow-up visit. Complete erectile dysfunction (ED) was noted in 74 patients (76.3%), partial ED in fifteen (15.5%), and 8 (8.2%) reported not they have not problems with their erectile function after surgery. Thirty-four patients (26.8%) presented biochemical progression, being the mean time to progression for the whole series 5.8 years (standard error 0.38). 2 and 5-year probability to remain free of biochemical progression were 71.2% and 58.8%, respectively. Only preoperative PSA (p = 0.023) and Gleason's score in the surgical specimen (p = 0.001) were identified as predictive variables for biochemical progression on the univariate analysis (log-rank). CONCLUSIONS: Radical prostatectomy offers acceptable results in terms of tolerability and short and mid-term survival. Preoperative PSA or Gleason's score in the surgical specimen may help to predict subsequent outcome of the disease.

Adult↗

PubMed2004

[Epidemiological trends in prostate cancer over the last years].

OBJECTIVES: To analyze the evolution of prostate cancer (PCa) in our community health area over the last years, in terms of incidence, clinical-epidemiological characteristics, and cancer-specific mortality. METHODS: Retrospective analysis of the medical records of patients with PCa in our hospital over the 1991-2003 period. We calculated the annual incidence rates for our community health area as well as its trend over the period of study. Changes of several clinical-epidemiological parameters over time were studied. The evolution of PCa mortality was also analyzed. RESULTS: 730 patients with PCa were evaluated. Median age and PSA at diagnosis were 69 years and 11.4 ng/ml, respectively. 60.5% tumors were detected in a localized clinical stage, and 18.6% were metastasic. 30.4% of PCa in the study (the most numerous group) had a Gleason score between 5 and 6. A constant increase of PCa incidence was observed with an annual percentage increase of 5.5% (p < 0.001). Standardized incidence rate for the year 2003 Spanish population pyramid was 100.9 cases/100,000 males. A significant trend to a greater proportion of PCa cases diagnosed by uncontrolled screening was observed, being the cases currently detected after symptoms only a small proportion (p < 0.001). Decreases in the age at diagnosis (p < 0.001), PSA level (p < 0.001), proportion of advanced clinical stages (p < 0.001), as well as proportion of cancers with well-differentiated Gleason score (2-4) (p < 0.001) were also detected. PCa mortality adjusted by the population pyramid was 8.7 deaths/100,000 males in the year 2003. CONCLUSIONS: We found an increase in the incidence of prostate cancer in our community health area over the last years, parallel to an increase in the proportion of cases detected by screening in asymptomatic population. Because of that, tumors currently detected tend to appear in younger ages, with lower PSA levels, and localized clinical stages.

Adult↗

PubMedDate not supplied

[Right transperitoneal laparoscopic nephroureterectomy].

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery.

Humans↗

PubMedDate not supplied

[Descriptive analysis of adverse events associated with transrectal prostatic biopsy after 603 procedures].

OBJECTIVES: To establish the incidence of complications secondary to performance of transrectal prostatic biopsy, and to establish the hypothetical relationship between the rate of fever and the type of antibiotic prophylaxis employed. METHODS: All patients undergoing transrectal prostatic biopsy between January 1992 and December 2003 were included in this prospective nonrandomized study. Patients were given a self-administered questionnaire to obtain data about complications related to biopsy that included the following variables: fever, hematuria, rectal bleeding, hemospermia, voiding difficulties, acute urinary retention, need to visit primary care physician or an emergency department, hospital admissions and need of medication. The incidence of observed complications was calculated and the relationship between post-biopsy fever and type of antibiotic prophylaxis employed (oral ciprofloxacin vs. intramuscular tobramycin) was studied by means of the chi-square test, using the SPSS 11.5 for Windows; a p < 0.05 was considered significant. RESULTS: Overall, 705 questionnaires were received; 603 (85.5%) were considered valid for processing. Almost three quarters (73.9%) of the patients undergoing biopsy presented some complications, being hematuria the most frequent (53% of the cases). 40 patients presented fever (6.64%). Among 360 patients treated with oral ciprofloxacin for three days 16 developed fever (4.4%), in comparison to 24 patients out of 243 treated with intramuscular tobramycin (9.87%) (p = 0.009). CONCLUSIONS: Ultrasound guided transrectal prostatic biopsy is associated with frequent complications, although most of them are mild. The most frequent complication is hematuria; fever is the most severe. To prevent post-biopsy fever, antibiotic prophylaxis with ciprofloxacin for three days is more effective than single dose intramuscular tobramycin. However, prospective randomize studies are required to confirm it.

Antibiotic Prophylaxis↗