martes, 3 de noviembre de 2009

La Cirugia minimamente Invasiva ,causa mas incontinencia y mas disfuncion erectil que la Prostatectomia abierta retropubica?

Un nuevo articulo publicado en Jama 2009:302(14)1557, nos dice que la prostatectomia minimamente invasiva (Robotica)causa mas incontinencia y mas disfuncion erectil que la cirugia abierta retropubica,.Esperamos que este articulo contribuya para esclarecer lo que se esta discutiendo en todos los ambitos urologicos del mundo,.
Cual sera la realidad?
Pronto tenedremos los numeros necesarios para aclarar esta controversia.
Lo que si es cierto en nuestras manos ,que solo hacemos Prostatectomia Abierta retropubica y en la cual tenemos una experiencia en el pais abundante,podemos decir que nuestro tiempo de operacion es corto(una hora hora y media)incontinencia,en nuestros primeros pacientes muy leve y los costos son mucho menores que las otra cirugias y la radioterapia,con resultados a 12 años muy buenos.
Disfuncion erectil: esperando a los 5 meses,tenemos que el 75% se recuperan y nos queda un 25% que no se recupera,pasarian a beneficiarse de uan protesis peneana.
DR.Ricardo Szemat Nikolajenko.Urologo.04142570173

Varicocele combinado con fumar empeora la motilidad y la morfologia

By Will Boggs, MD

NEW YORK (Reuters Health) Oct 26 - Smoking combines with varicocele to worsen sperm motility and morphology, say researchers from Italy in the October Urology.

"The present study indicates a negative synergic effect of cigarette smoking and varicocele: another strong reason to stop smoking," Dr. Elena Moretti from the University of Siena told Reuters Health. "The main message of the present research should be to implement effective interventions targeted to encourage men to quit smoking in order to improve general health and also their fertility potential."

Dr. Moretti and colleagues investigated whether smoking increases the adverse effects of varicocele on sperm morphology and function in a study of 121 smokers and 158 nonsmokers with varicocele.

Progressive sperm motility was lower in both groups compared to World Health Organization values, the authors report, but the difference between smokers and nonsmokers was not significant.

Similarly, the percentage of immaturity, necrosis, and apoptosis were significantly lower than reference values in men with varicocele, but the values did not differ significantly between smokers and nonsmokers.

When the smokers were categorized according to their daily cigarette usage, however, sperm concentration, progressive motility, apoptosis, immaturity, and necrosis were all significantly worse among heavy and moderate smokers than among mild smokers.

"I believe that the most important point to be stressed is to persuade males to quit smoking as soon as possible, as it has been reported that reduced fecundity associated with smoking may in great part be reversed within a year of smoking cessation," Dr. Moretti said.

"The study of the relationship between smoking and varicocele, which we have shown to affect sperm characteristics, is the first step in the research we have undertaken to discover the determinants of sperm injury," Dr. Moretti added. "It should be of pivotal interest to consider other putative mechanisms of damage, in addition to free oxygen species release due to smoking and the presence of varicocele (widely reported in the literature)

Urology 2009;74:794-800.
Comentario RSZN; El dr moretti piensa que esta es la primera etapa en esa investigacion para descubrir las determinantes en la injuria del espermatozoide y buscar otros mecanismos de daño,aparte de la liberacion de " especies oxigeno libre" debido al fumar y la presencia de Varicocele.

DR Ricardo Szemat Nikolajenko;urologo.

clitorisvaginavejigasalud

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hormonas yosteoporosis en el hombre

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