33 results on '"Galán Llopis, Juan Antonio"'
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2. Bladder Cancer and Probiotics: What Do We Know So Far?
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Sánchez-Pellicer, Pedro, primary, Boix-Rodríguez, Claudia, additional, Hernández-Belmonte, Adriana, additional, Encarnación-Castellano, Cristina de la, additional, Mendiola-López, Alberto, additional, Núñez-Delegido, Eva, additional, Navarro-Moratalla, Laura, additional, Agüera-Santos, Juan, additional, Navarro-López, Vicente, additional, and Galán-Llopis, Juan Antonio, additional
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- 2023
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3. Dificultades al aplicar la escala Post-Ureteroscopic Lesion Scale para determinar la gravedad de las lesiones de la pared ureteral
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Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Polo, Rebeca, Canós-Nebot, Àngela, Caballero-Romeu, Juan-Pablo, Caballero, Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, De La Cruz-Conty, Julia E., Tuells, José, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Polo, Rebeca, Canós-Nebot, Àngela, Caballero-Romeu, Juan-Pablo, Caballero, Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, De La Cruz-Conty, Julia E., and Tuells, José
- Abstract
Objetivo: Analizar el nivel de concordancia de la Post-Ureteroscopic Lesion Scale (PULS), y examinar las consecuencias de su aplicación en la práctica clínica con datos estadísticos más fiables que los utilizados en el trabajo original. Métodos: Se realizaron 14 ureteroscopias (URS) y 14 micro-ureteroscopias (micro-URS) en 14 cerdos hembra. Todos los procedimientos se grabaron en vídeo y se realizó un análisis anatomopatológico en cada uréter. Dieciséis urólogos (9 endourólogos y 7 urólogos generales) y 4 médicos internos evaluaron las lesiones ureterales según la escala PULS, con grados 0, 1 y ≥ 2. La concordancia se calculó mediante porcentajes, el Coeficiente W de Kendall, el índice kappa de Fleiss y el alfa de Krippendorff. La concordancia entre evaluadores se calculó con la Correlación de Spearman y el Coeficiente kappa de Cohen. Resultados: El porcentaje de concordancia fue del 11,1%. Los coeficientes se clasificaron como bajos o muy bajos, y encontramos una mayor concordancia entre los evaluadores sin experiencia. Por otro lado, no hubo acuerdo/concordancia en/entre el 50% de los evaluadores. Conclusiones: La baja concordancia entre evaluadores, la especificidad de la PULS y la correlación clínico/patológica sugieren las dificultades del uso de esta escala y una curva de aprendizaje probablemente larga., Objective: To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. Methods: 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. Results: The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. Conclusions: The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.
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- 2023
4. Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ
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Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Polo, Rebeca, Canós-Nebot, Àngela, Caballero-Romeu, Juan-Pablo, Caballero, Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, De La Cruz-Conty, Julia E., Tuells, José, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Polo, Rebeca, Canós-Nebot, Àngela, Caballero-Romeu, Juan-Pablo, Caballero, Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, De La Cruz-Conty, Julia E., and Tuells, José
- Abstract
Objective: To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. Methods: 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall’s W coefficient and the indicators Fleiss’ Kappa and Krippendorff’s Alpha, while the inter-rater agreement was calculated with Spearman’s correlation and Cohen’s Kappa. Results: The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. Conclusions: The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve., Objetivo: Analizar el nivel de concordancia de la Post-Ureteroscopic Lesion Scale (PULS), y examinar las consecuencias de su aplicación en la práctica clínica con datos estadísticos más fiables que los utilizados en el trabajo original. Métodos: Se realizaron 14 ureteroscopias (URS) y 14 micro-ureteroscopias (micro-URS) en 14 cerdos hembra. Todos los procedimientos se grabaron en vídeo y se realizó un análisis anatomopatológico en cada uréter. Dieciséis urólogos (9 endourólogos y 7 urólogos generales) y 4 médicos internos evaluaron las lesiones ureterales según la escala PULS, con grados 0, 1 y ≥2. La concordancia se calculó mediante porcentajes, el coeficiente W de Kendall, el índice Kappa de Fleiss y el Alfa de Krippendorff. La concordancia entre evaluadores se calculó con la correlación de Spearman y el coeficiente Kappa de Cohen. Resultados: El porcentaje de concordancia fue del 11,1%. Los coeficientes se clasificaron como bajos o muy bajos, y encontramos una mayor concordancia entre los evaluadores sin experiencia. Por otro lado, no hubo acuerdo/concordancia en/entre el 50% de los evaluadores. Conclusiones: La baja concordancia entre evaluadores, la especificidad de la PULS y la correlación clínico-patológica sugieren las dificultades del uso de esta escala y una curva de aprendizaje probablemente larga.
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- 2023
5. Incidence of Bladder Cancer in Patients Undergoing Radiotherapy for Prostate Cancer
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de la Encarnación Castellano, Cristina, primary, Canóns Nebot, Ángela, primary, Vargas Andreu, Pablo, primary, García Carbajosa, Nuria, primary, Prieto Chaparro, Luis, primary, Chllón Sempere, Silvia, primary, and Galán Llopis, Juan Antonio, primary
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- 2022
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6. PELVIC URETERAL STONES IN WOMEN: MICROURETEROSCOPY REDUCES THE NEED FOR URETERAL STENTING COMPARED TO CONVENTIONAL URETEROSCOPY.: MP22-06
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Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Pérez-Seoane, Helena, Garcia-Segui, Alejandro-Jose, Verges-Prosper, Aleixandre, and Amorós-Torres, Araceli
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- 2016
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7. V6-13 MICROURETEROSCOPY: MINIATURIZATION FOR THE TREATMENT OF URETERAL STONES
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Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Garcia-Segui, Alejandro, Verges, Aleixandre, and Amorós-Torres, Araceli
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- 2015
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8. Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure
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Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, Morcillo-Martín, Esther, Caballero, Pablo, Garcia, Alejandro, De La Cruz-Conty, Julia E., Romero-Maroto, Jesús, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, Morcillo-Martín, Esther, Caballero, Pablo, Garcia, Alejandro, De La Cruz-Conty, Julia E., and Romero-Maroto, Jesús
- Abstract
Purpose Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS. Methods A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured. Results The range of average pressures was 5.08–14.1 mmHg in the m-URS group and 6.08–20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001). Conclusions m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
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- 2018
9. Outcomes of ureteroscopy miniaturization on tissue damage and tissue hypoxia in a pig model
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Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, Morcillo-Martín, Esther, Caballero, Pablo, De La Cruz-Conty, Julia E., Romero-Maroto, Jesús, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Soria, Federico, Morcillo-Martín, Esther, Caballero, Pablo, De La Cruz-Conty, Julia E., and Romero-Maroto, Jesús
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Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.
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- 2018
10. TRATAMIENTO MÉDICO EXPULSIVO DE LA LITIASIS URETERAL.
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Canós Nebot, Ángela, de la Encarnación Castellano, Cristina, Caballero Romeu, Juan Pablo, and Galán Llopis, Juan Antonio
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- 2021
11. TRATAMIENTO MÉDICO DEL CÓLICO RENOURETERAL EN SU FASE AGUDA.
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de la Encarnación Castellano, Cristina, Canós Nebot, Àngela, Caballero Romeu, Juan Pablo, and Galán Llopis, Juan Antonio
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- 2021
12. TERAPIA DE DEPRIVACIÓN ANDROGÉNICA EN CÁNCER DE PRÓSTATA AVANZADO. ESTUDIO MULTICÉNTRICO.
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Valencia-Guadalajara, Victor José, Martínez-Cayuelas, Laura, Sarrió-Sanz, Pau, Sánchez Caballero, Laura, Polo-Hernández, Rebeca, Chillón-Sempere, Francisca Silvia, Galán Llopis, Juan Antonio, Garcés-Valverde, Marina, Tenza-Tenza, José Antonio, Costa-Martínez, Asunción, Serrado-Paumard, Diego García, Escudero-Fontana, Eva, Tello-Royloa, Carlos, Verdú Verdú, Lidia Patricia, Bravo-López, Diego Fernando, Seoane-Ballester, Helena Pérez, Pacheco-Bru, Juan José, and Ortiz-Gorraiz, Manuel Ángel
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- 2020
13. Technical considerations about micro-ureteroscopy in children
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Hernández, Rebeca Polo, primary, Caballero Romeu, Juan Pablo, additional, Galiano Baena, Juan Francisco, additional, Montoya Lirola, María Dolores, additional, García Tabar, Pedro José, additional, Galán Llopis, Juan Antonio, additional, Gonzálvez Piñera, Jerónimo, additional, Mira Marcelí, Nuria Albertos, additional, and Budía Alba, Alberto, additional
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- 2017
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14. Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study
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Caballero-Romeu, Juan-Pablo, primary, Galán-Llopis, Juan-Antonio, additional, Pérez-Fentes, Daniel, additional, Budia-Alba, Alberto, additional, Cepeda-Delgado, Marcos, additional, Palmero-Marti, Jose-Luis, additional, Cansino-Alcaide, Jose-Ramón, additional, Caballero-Pérez, Pablo, additional, and Ibarluzea-Gonzalez, Gaspar, additional
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- 2016
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15. Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study
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Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Pérez-Fentes, Daniel, Budia-Alba, Alberto, Cepeda-Delgado, Marcos, Palmero-Marti, Jose-Luis, Cansino-Alcaide, Jose-Ramón, Caballero, Pablo, Ibarluzea-Gonzalez, Gaspar, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Caballero-Romeu, Juan-Pablo, Galán-Llopis, Juan-Antonio, Pérez-Fentes, Daniel, Budia-Alba, Alberto, Cepeda-Delgado, Marcos, Palmero-Marti, Jose-Luis, Cansino-Alcaide, Jose-Ramón, Caballero, Pablo, and Ibarluzea-Gonzalez, Gaspar
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Purpose: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. Materials and Methods: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. Results: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. Conclusions: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to “conventional” ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.
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- 2016
16. MANEJO MÉDICO DE LA LITIASIS URINARIA.
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Galán LLopis, Juan Antonio
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- 2021
17. MP22-06 PELVIC URETERAL STONES IN WOMEN: MICROURETEROSCOPY REDUCES THE NEED FOR URETERAL STENTING COMPARED TO CONVENTIONAL URETEROSCOPY.
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Caballero-Romeu, Juan-Pablo, primary, Galán-Llopis, Juan-Antonio, additional, Pérez-Seoane, Helena, additional, Garcia-Segui, Alejandro-Jose, additional, Verges-Prosper, Aleixandre, additional, and Amorós-Torres, Araceli, additional
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- 2016
- Full Text
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18. MICROURS ¿UNA TÉCNICA PARA QUEDARSE?
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Caballero-Romeu, Juan Pablo and Galán-Llopis, Juan Antonio
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- 2017
19. REFINAMIENTOS PRÁCTICOS EN LA PIELOPLASTIA LAPAROSCÓPICA SIMPLIFICADA.
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García-Segui, Alejandro, Verges, Aleixandre, Galán Llopis, Juan Antonio, Amorós, Araceli, Pérez-Seoane, Helena, and Escudero, Eva
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- 2016
20. Cuadro oclusivo por tuberculosis gastrointestinal
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Ventayol Clar, Gabriel, López Celada, Susana, Galán Llopis, Juan Antonio, Martínez Meléndez, Salvador, Salinas García, Ramón, and García Sanz, Mario
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Tuberculosis - Published
- 1995
21. UROLITIASIS: Desde la formación al tratamiento y la prevención.
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Galán Llopis, Juan Antonio
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- 2017
22. Estudio para la validación de la técnica de microureteroscopia en modelo animal porcino
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Caballero Romeu, Juan Pablo, Romero Maroto, Jesús, Soria Gálvez, Federico, Galán Llopis, Juan Antonio, and Departamentos de la UMH::Patología y Cirugía
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Urología ,6 - Ciencias aplicadas::61 - Medicina::616 - Patología. Medicina clínica. Oncología [CDU] ,Cirugía urológica - Abstract
Programa de Doctorado en Salud Pública, Ciencias Médicas y Quirúrgicas Antecedentes: La ureteroscopia produce efectos adversos como la estenosis ureteral, la fiebre o la sepsis de origen urinario. Estas complicaciones están relacionadas con la lesión de la pared ureteral, la isquemia o la elevación de la presión intrapiélica. Sin embargo, los efectos mecánicos microscópicos y macroscópicos, así como la hipoxia tisular asociada al procedimiento, no han sido estudiados de manera adecuada. La miniaturización de la ureteroscopia pretende reducir los efectos adversos asociados a esta técnica. Objetivo(s): El objetivo principal es demostrar que la ureteroscopia realizada con la vaina de 4,85 Fr. del equipo de micro-Perc® produce menos efectos adversos que el ureteroscopio de 8/9,8 Fr. Se compararon los efectos microscópicos y macroscópicos de la microureteroscopia y de la ureteroscopia (8/9,8 Fr.). También se comparó la presión intrapiélica y los cambios hemodinámicos renales, mientras se realizaba la microureteroscopia y la ureteroscopia (8/9,8 Fr.). Métodos: Para llevar a cabo este estudio experimental se emplearon 14 ejemplares de la especie porcina de la raza Large White. Se realizó una ureteroscopia (8/9,8 Fr.) en uno de los uréteres mientras que se empleó la vaina de 4,85 Fr. de microureteroscopia en el uréter contralateral. En ambos casos se introdujo 21 cm de cada instrumento. Dos cirujanos realizaron 7 ureteroscopias, durante 45 minutos, y 7 icroureteroscopias, durante 60 minutos. En total, se realizaron 28 procedimientos en 14 animales. Se utilizó un catéter para medir la presión intrapiélica cada 5 minutos. Mediante ecografía Doppler se valoró los parámetros hemodinámicos renales. También se midió el volumen de suero de irrigación. Se determinó el daño macroscópico producido en el orificio ureteral y en la pared ureteral. El daño tisular microscópico y la hipoxia ureteral se objetivaron mediante la tinción con hematoxilina-eosina y con inmunohistoquímica (pimonidazol) respectivamente. Background: Miniaturization of ureteroscopy materials is intended to decrease tissue damage and adverse effects. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. Moreover, ureteroscopy is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure during the procedure. Purpose(s): The aim is to demonstrate that a ureteroscopy employing the 4.85 Fr. sheath of microPerc® produces less adverse effects than an 8/9.8 Fr. ureteroscope. We compared the gross and microscopic effects of micro-ureteroscopy and 8/9.8Fr. ureteroscopy on the urinary tract. We also compared intrapelvic pressure and changes in renal haemodynamics, while performing micro-ureteroscopy vs. 8/9.8 Fr. ureteroscopy. Methods: We employed 14 pigs of the Large White race in this experimental study. A ureteroscopy was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Two surgeons performed 7 8/9.8 Fr. ureteroscopies, for 45 min, and 7 micro-ureteroscopies (4.85 Fr.), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry (pimonidazole) for detection of tissue hypoxia were conducted.Results: Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using 8/9.8 ureteroscopy (C = 0.8), but not with microureteroscopy. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the ureteroscopy group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. The range of average intrapelvic pressures was 5.08–14.1 mmHg in the micro-ureteroscopy group and 6.08–20.64 mmHg in the 8/9.8 Fr. ureteroscopy (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with micro-ureteroscopy, as compared to 65% of renal units in the 8/9.8 Fr. ureteroscopy group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the 8/9.8 Fr. ureteroscopy group and from 19.26 to 12.87 cm/s in the micro-ureteroscopy group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 ml in the micro-ureteroscopy group and 1475 ml in the 8/9.8 Fr. ureteroscopy group (p < 0.001). Conclusions: Micro-ureteroscopy causes less damage to the ureteral orifice than ureteroscopy. Histopathological findings show micro-ureteroscopy reduces ureteral epithelial damage compared with conventional ureteroscopy. Both 8/9.8 Fr. ureteroscopy and micro-ureteroscopy cause cellular hypoxia. Micro-ureteroscopy requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
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- 2018
23. Management of urinary stones: state of the art and future perspectives by experts in stone disease.
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Papatsoris A, Alba AB, Galán Llopis JA, Musafer MA, Alameedee M, Ather H, Caballero-Romeu JP, Costa-Bauzá A, Dellis A, El Howairis M, Gambaro G, Geavlete B, Halinski A, Hess B, Jaffry S, Kok D, Kouicem H, Llanes L, Lopez Martinez JM, Popov E, Rodgers A, Soria F, Stamatelou K, Trinchieri A, and Tuerk C
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- Humans, Forecasting, Urinary Calculi therapy, Urinary Calculi surgery
- Abstract
Aim: To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024. Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity. Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents. Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture). Diagnostic work up: Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies., Prophylaxis: Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most "high-risk" patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at "high-risk" forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched., Future Research: Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation.
- Published
- 2024
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24. Biodegradable ureteral stents: in vitro assessment of the degradation rates of braided synthetic polymers and copolymers.
- Author
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de la Cruz JE, Soto M, Martínez-Plá L, Galán-Llopis JA, Sánchez-Margallo FM, and Soria F
- Abstract
Objectives: The control and predictability of degradation rates and the absence of obstructive phenomena are two main challenges for research regarding biodegradable ureteral stents. The objectives are to assess the degradation performance and safety of braided combinations of three synthetic biodegradable polymers and copolymers; and to evaluate the interference of a heparin dip coating on degradation and bacterial colonization., Methods: The hydrolysis of polyglycolic acid (PGA), poly lactic-co-glycolic acid (PLGA) and Glycomer™ 631 is assessed in this in vitro study that comprises ten groups. Stent samples present a braided arrangement and are incubated in porcine urine that undergoes analysis and exchange every 48 h until degradation. Coating is carried out with sodium heparin via dip coating and determination of the heparin release is carried out by ELISA test. Variables of study are stent mass, mass fold change, degradation time, bacterial colonization and concentration of heparin released in artificial urine., Results: There is statistical significance in degradation times between all materials except between the Glycomer™ 631 alone and combined with PGA. Mass fold change analysis of the Glycomer™ 631 evidences an increasing trend of its mass during degradation. The combination of Glycomer™ 631 and PGA presents a progressive and gradual degradation, where PGA degrades at week 3 while Glycomer™ 631 remains intact until its fragmentation at the late stage of degradation. Heparin coating has no significant impact on mean degradation times and trends in any group, nor on bacteriuria rates; heparin concentration decreases significantly after 72 h. Products of degradation are released steadily with minimum dimensions., Conclusions: The combination of synthetic biodegradable polymers and copolymers with different degradation rates provides a gradual staged degradation. Heparin dip coating is a safe and feasible technique to coat biodegradable ureteral stents without interfering in degradation rates although it does not have a significant effect on the onset of bacterial colonization., Competing Interests: None., (AJCEU Copyright © 2022.)
- Published
- 2022
25. Medical management of urolithiasis.
- Author
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Galán LLopis JA
- Subjects
- Child, Female, Humans, Incidence, Acidosis, Renal Tubular, Calculi, Urolithiasis therapy
- Abstract
Urolithiasis is a multifactorial and recurrent disease whose incidence is increasing, especially in women but also in the paediatric population. Differences can be found between different regions and between different ethnicities, often due to dietary and environmental factors, without forgetting the genetic influence on different types of stones. There are disease sthat require a high index of suspicion in order to reach a diagnosis, such as renal tubular acidosis (RTA), not only for the benefit of the patient but also for their family members in the case a genetic mutation. Calcium-based stones continue to be the most frequent, but with a progressive increase in uric stones...
- Published
- 2021
26. Medical treatment for acute renal colic.
- Author
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de la Encarnación Castellano C, Canós Nebot À, Caballero Romeu JP, and Galán Llopis JA
- Subjects
- Analgesics, Opioid therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Female, Humans, Pain, Pregnancy, Colic drug therapy, Renal Colic drug therapy
- Abstract
Introduction: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acutephase., Aims: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renalcolic", "treatment", "anti-inflammatory drugs", "antiemeticdrugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed., Results: In the different studies reviewed, non-steroidalanti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU., Conclusions: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice.
- Published
- 2021
27. [Medical expulsive treatment for ureteral stones.]
- Author
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Canós Nebot Á, de la Encarnación Castellano C, Caballero Romeu JP, and Galán Llopis JA
- Subjects
- Adrenergic alpha-Antagonists, Child, Female, Humans, Pregnancy, Treatment Outcome, Ureteroscopy, Lithotripsy, Ureter, Ureteral Calculi drug therapy
- Abstract
Introduction: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years., Objectives: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy)., Material and Methods: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed)., Results: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment., Conclusions: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.
- Published
- 2021
28. [Androgen deprivation therapy in advanced prostate cancer. Multicenter study.]
- Author
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Valencia-Guadalajara VJ, Martínez-Cayuelas L, Sarrió-Sanz P, Sánchez-Caballero L, Polo-Hernández R, Chillón-Sempere FS, Galán-Llopis JA, Garcés-Valverde M, Tenza-Tenza JA, Costa-Martínez A, García Serrado-Paumard D, Escudero-Fontana E, Tello-Royloa C, Verdú-Verdú LP, Bravo-López DF, Pérez Seoane-Ballester H, Pacheco-Bru JJ, and Ortiz-Gorraiz MÁ
- Subjects
- Aged, Androgen Antagonists therapeutic use, Humans, Male, Orchiectomy, Prostate-Specific Antigen, Prostatectomy, Retrospective Studies, Prostatic Neoplasms therapy
- Abstract
Objectives: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC)., Material and Methods: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test., Results: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria.In this group 21.7% achieved undetectable PSA (group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p <0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT., Conclusions: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA<0.1 ng/ml after ADT is presented as an indicator of progression to the CRPC stage.
- Published
- 2020
29. [Urinary lithiasis. The patient also plays.]
- Author
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Galán Llopis JA, Vergés Prósper A, Pérez-Seoane Ballester H, Escudero Fontano E, and Tortolero Blanco L
- Subjects
- Humans, Patient Compliance, Patient Participation, Urolithiasis therapy
- Abstract
Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis' patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way.
- Published
- 2017
30. [Urinary lithiasis: From Stone formation to treatment and prevention.]
- Author
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Galán Llopis JA
- Subjects
- Humans, Urolithiasis etiology, Urolithiasis prevention & control, Urolithiasis therapy
- Published
- 2017
31. [MicroURS. Is it a technique to stay?]
- Author
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Caballero-Romeu JP and Galán-Llopis JA
- Subjects
- Equipment Design, Female, Humans, Male, Ureteroscopes, Ureteral Calculi surgery, Ureteroscopy methods
- Abstract
Micro-ureteroscopy is a novel technique derived from the need to reduce the morbidity associated with conventional ureteroscopy. Reducing morbidity, we will be able to improve quality of life of patients, for example, by shortening the times to elimination of the stones. In this article the authors intend to expose the different applications of micro ureteroscopy as well as the incipient scientific evidence on the topic.
- Published
- 2017
32. [Practical refinaments in simplified laparoscopic pyeloplasty].
- Author
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García-Segui A, Verges A, Galán Llopis JA, Amorós A, Pérez-Seoane H, and Escudero E
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Kidney Pelvis surgery, Laparoscopy methods, Ureteral Obstruction surgery
- Abstract
Objectives: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices., Methods: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively., Results: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases., Conclusions: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.
- Published
- 2016
33. [Spontaneous pre-vesical haematoma in a patient under anticoagulant treatment].
- Author
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Menéndez López V, Galán Llopis JA, Carro Rubias C, Lloréns Martínez FJ, and García López F
- Subjects
- Aged, Drainage methods, Female, Hematoma diagnostic imaging, Hematoma surgery, Humans, Tomography, X-Ray Computed, Treatment Outcome, Urinary Bladder Diseases diagnostic imaging, Urinary Bladder Diseases surgery, Anticoagulants adverse effects, Hematoma chemically induced, Heparin adverse effects, Urinary Bladder Diseases chemically induced
- Abstract
Objectives: To report a case of perivesical hematoma without previous trauma in a patient under anticoagulant treatment., Methods: A 70-year-old female admitted with a transitory ischemic cerebrovascular accident was given sodium heparin. Four days later she presented with abdominal distention and hypogastric discomfort. Abdominal ultrasound showed a big perivesical hematoma., Results: CT scan confirmed the presence of a big hematoma. The hematoma was drained five days later after an optimal coagulation profile. Patient was discharged with normal ultrasound after an uneventful postoperative course., Conclusions: Spontaneous bleeding in patients with coagulation abnormalities is a well-known event, although there are few bibliographic references about primary perivesical blood collections. We opted for deferred drainage of the hematoma to avoid perivesical fibrosis.
- Published
- 2003
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