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.

nueva clasificacion de los tumores renales

Monday, 17 August 2009
RIO DE JANEIRO, BRAZIL (UroToday.com) - Clear cell carcinoma occurs in 60% of resected adult tumors. They are yellow tumors with nests of clear cytoplasm and express many growth factors including VEGF, EGFR and Carbonic anhydrase. VHL gene mutations are present.
Papillary cancers comprise 15% of resected adult tumors. Type I has very good survival and type II poor survival. It is unclear if they are really distinct entities molecularly.
Chromophobe renal tumors comprise 5% of adult renal tumors and they have a greater than 90% 10-year survival. While they can have very aggressive sarcomatoid variants, it is rare. They are generally unifocal tumors with large cells that can be confused with oncocytomas due to large amount of pink cytoplasm.
Collecting duct tumors are seen in less than 1% of all renal tumors. They occur in young patients and are very aggressive. They are infiltrative versus circumscribed and virtually indistinguishable from urothelial cancer or renal pelvic tumors. Medullary tumors occur only in patients with sickle cell trait and are uniformly lethal within 6 months.
Finally, mucinous tubular and spindle cell tumors are new entities in the classification system. They are low grade and occur predominately in women.
Presented by David Grignon, MD at the VI Maratona Urológica do Rio de Janeiro - August 14 - 15, 2009.

52-semanas de tratamiento con dieta y ejercicio, junto con la testosterona transdérmica Invierte el síndrome metabólico y la Mejora de control de la g

BERKELEY, CA (UroToday.com) - Antes se creía firmemente que la testosterona no tenía ningún papel esencial que desempeñar en la fisiología masculina, excepto en el funcionamiento sexual y reproductiva. En los últimos tres decenios se ha hecho evidente que la testosterona desempeña un papel importante en la homeostasis de la glucosa y el metabolismo de los lípidos. El síndrome metabólico es una agrupación de factores de riesgo que predisponen a la diabetes mellitus tipo 2, la aterosclerosis y la morbilidad y mortalidad cardiovascular. Los principales componentes del síndrome son la obesidad visceral, resistencia a la insulina, intolerancia a la glucosa, hipertensión y dislipidemia (niveles elevados de triglicéridos, niveles bajos de colesterol de lipoproteínas de densidad), y un estado pro-inflamatorio y trombogénico. Transversal estudios epidemiológicos han informado de una correlación directa entre la testosterona plasmática y la sensibilidad a la insulina y niveles bajos de testosterona se asocian con un mayor riesgo de diabetes mellitus tipo 2, dramáticamente ilustrado por la privación de andrógenos en hombres con cáncer de próstata. Recientes estudios epidemiológicos han encontrado que los niveles bajos de testosterona son un factor predictivo de mortalidad en hombres de edad avanzada. La testosterona total más bajo y la hormona sexual globulina fijadora de predecir una mayor incidencia del síndrome metabólico. Actualmente existen pruebas para sostener que hypotestosteronemia debe ser un elemento en la definición del síndrome metabólico ya que los niveles bajos de testosterona se asocian con o predecir el desarrollo del síndrome metabólico y la diabetes mellitus. La administración de testosterona a los hombres hipogonadales invierte parte del perfil de riesgo desfavorable para el desarrollo de la diabetes y la aterosclerosis y mejora la sensibilidad a la insulina. Hasta ahora, los estudios con puntos finales clínicos sobre los efectos de la normalización de la testosterona en los hombres hipogonadales en la homeostasis de la glucosa son limitados, pero convincente, y si la diabetes mellitus es considerada en el contexto del síndrome metabólico, los presentes resultados del tratamiento con testosterona son muy alentadores. Los médicos tienen que cambiar su mentalidad y aceptar que la testosterona es una hormona vital para la salud de los hombres. Por lo general, los médicos que tratan a los hombres con diabetes mellitus no están muy familiarizados con el pato () la fisiología de la testosterona, como se indicó anteriormente, tradicionalmente pensado para servir el funcionamiento sexual solamente. Es de esperar que estos médicos a desarrollar una visión más amplia de las funciones de la testosterona en la vida adulta y la vejez. La testosterona no será una panacea, pero el tratamiento de la diabetes mellitus tipo 2 es rara vez se basa en una sola entidad. Nuestro estudio demostró que la testosterona, además de los efectos saludables de ejercicio y la dieta, mejoró el control glucémico y en no pocos pacientes llevado a un estado de salud ya no calificar como el síndrome metabólico. Escrito por: Louis J. Gooren, MD, como parte de Más allá del resumen de UroToday.com. Esta iniciativa ofrece un método de publicación para la comunidad profesional de la urología. Los autores se les da la oportunidad de ampliar las circunstancias, limitaciones, etc .. de sus investigaciones con referencia a la publicación abstracto. 52-semanas de tratamiento con dieta y ejercicio, junto con la testosterona transdérmica Invierte el síndrome metabólico y la Mejora de control de la glucemia en los hombres con diagnóstico reciente de diabetes tipo 2 y subnormales de testosterona en plasma
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evaluacion del papel del sistema sertoninergico en el control del musculo liso de la vesicula seminal humana.Una manera de entenderla in vitro.

Evaluating the Role of the Serotoninergic System in the Control of Human Seminal Vesicle Smooth Muscle—An in Vitro Approach

Ponco Birowo, MD,*^† Stefan Ückert, PhD,* George T. Kedia, MD,* Friedemann Scheller, ^‡ Markus Meyer, MD, PhD, ^§ AkmalTaher, MD, PhD, ^† Djoko Rahardjo, MD, PhD, ^† Udo Jonas, MD, PhD,* and Markus A. Kuczyk, MD, PhD*

*Department of Urology & Uro-Oncology, Hannover Medical School, Hannover, Germany; ^† Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany; ^‡ Department of Urology, Cipto Mangunkusumo Hospital, University of Indonesia School of Medicine, Jakarta, Indonesia; ^§ FOCUS IP AG, Basel, Switzerland

Correspondence to Stefan Ückert, PhD, Hannover Medical School, Department of Urology & Uro-Oncology, 30625 Hannover, Germany. Tel: +49 (0)511-5-32-34-37; Fax: +49 (0)511-5-32-84-37; E-mail: sue_de_99@yahoo.de

KEYWORDS

Human Seminal Vesicles • Serotonin • Serotonin Re-Uptake Inhibitors • Cyclic Nucleotide Monophosphates • Premature Ejaculation

ABSTRACT

Introduction. It has been suggested that serotonin re-uptake inhibitors (SRIs) may retard the ejaculatory response by acting directly on the seminal vesicle (SV) and ductus deferens smooth muscle. However, until now, only a very few experimental studies have investigated such potential local (peripheral) effects.

Aim. To elucidate the effects of serotonin (5-HT) and the SRIs clomipramine, fluoxetine and imipramine on the tension induced by norepinephrine (NE) of isolated human SV smooth muscle, as well as on the production of tissue cyclic AMP and cyclic GMP.

Main Outcome Measures. To measure the inhibition exerted by serotonin and SRIs clomipramine, fluoxetine, and imipramine on the contractile response of isolated SV tissue. In addition, the effects of the drugs on the turn-over of cyclic nucleotides cAMP and cGMP were also elucidated.

Methods. The effects of the cumulative addition of serotonin and the SRIs clomipramine, fluoxetine and imipramine (1 nM–10 µM) on the tension induced by the alpha₁-adrenoceptor agonist NE (10 µM) of SV strip preparations were studied using the organ bath technique. Cyclic AMP and cyclic GMP were measured by means of specific radioimmunoassays.

Results. The tension induced by NE was dose-dependently reversed by the drugs tested. The rank order of efficacy was: imipramine ≥ fluoxetine ≥ clomipramine > serotonin. Mean reversion of tension was measured between 66 ± 6.6% and 52 ± 6.6%. These effects were paralleled by a 1.3-fold to 2.7-fold increase in tissue cAMP in response to exposure to the drugs. In contrast, no significant enhancement in cGMP was noted.

Conclusions. The findings, for the first time, present evidence that SRIs may antagonize the sympathetic contraction of SV smooth muscle via stimulation of tissue cyclic AMP. Birowo P, Ückert S, Kedia GT, Scheller F, Meyer M, Taher A, Rahardjo D, Jonas U, and Kuczyk MA. Evaluating the role of the serotoninergic system in the control of human seminal vesicle smooth muscle—An in vitro approach. J Sex Med **;**:**–**.

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DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1743-6109.2009.01423.x About DOI

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La vacuna del VPH(virus de papiloma Humano)puede prevenir muchos casos de carcinoma de Pene

NEW YORK (Reuters Health) 24 - Casi la mitad de los cánceres de pene son asociados con la infección por el alto riesgo del virus del papiloma humano (VPH-16 y VPH-18), los resultados de un meta-análisis indican grandes. "Disponible vacunas contra el VPH es probable que sea eficaz en los tumores de pene," la Dra. Silvia de Sanjosé y colaboradores sugieren en el Journal of Clinical Pathology, publicado en línea el 25 de agosto. El carcinoma de pene es relativamente rara en los países desarrollados, que representan menos del 1% de los cánceres de adultos varones en Europa y América del Norte, señalan los autores. La incidencia es mucho mayor en otras regiones, causando hasta el 10% de todos los tumores malignos en los hombres en América del Sur, África y Asia. Para examinar el papel del VPH en determinados subtipos histológicos de cáncer de pene, el Dr. de Sanjosé, del Instituto Catalán de Oncología de Barcelona, España, y su equipo realizó una revisión bibliográfica sistemática y exhaustiva de los principales estudios de cáncer de pene, publicados entre 1986 y 2008. Incluido en su análisis fue de 31 estudios que incluyeron 1466 pacientes con carcinoma de pene. La prevalencia global de VPH fue 46,9%, la mayoría de los cuales eran los tipos de alto riesgo cubierto por la vacuna contra el VPH actual: HPV-16 (60%), HPV-18 (13%), y HPV-6/11 (8%) . "Basaloide y verrugosas carcinomas de células escamosas fueron el VPH más frecuentes relacionadas con los tipos histológicos", señala el estudio en equipo ", pero queratinizado y no queratinizado subtipos también mostraron tasas de prevalencia de alrededor del 50%." El Dr. de Sanjosé y colaboradores señalan que la vacuna profiláctica contra el VPH en los hombres parece ser segura e inmunogénica. Ellos proponen que, "a pesar de carcinoma de pene es una enfermedad rara, alrededor de 7000 casos podría evitarse anualmente por la erradicación de VPH 16/18." J Clin Pathol 2009.

El uso de la hemoglobina A1C para el diagnostico de Diabetes.

une 7, 2009 (New Orleans, Louisiana) — The American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) have joined forces to recommend the use of the hemoglobin A1C assay for the diagnosis of diabetes.

The international expert committee's recommendations were announced here on Friday during the opening hours of the ADA's 69th Scientific Sessions and released simultaneously online in the July issue of Diabetes Care.

"This is the first major departure in 30 years in diabetes diagnosis," committee chairman David M. Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School in Boston, declared in presenting the committee's findings.

"A1C values vary less than FPG [fasting plasma glucose] values and the assay for A1C has technical advantages compared with the glucose assay," Dr. Nathan said. A1C gives a picture of the average blood glucose level over the preceding 2 to 3 months, he added.

"A1C has numerous advantages over plasma glucose measurement," Dr. Nathan continued. "It's a more stable chemical moiety.... It's more convenient. The patient doesn't need to fast, and measuring A1C is more convenient and easier for patients who will no longer be required to perform a fasting or oral glucose tolerance test.... And it is correlated tightly with the risk of developing retinopathy."

A disadvantage is the cost. "It is more expensive," Dr. Nathan acknowledged. However, cost analyses have not been done, "...and costs are not the same as charges [to the patient]."

The committee has determined that an A1C value of 6.5% or greater should be used for the diagnosis of diabetes.

This cut-point, Dr. Nathan said, "is where risk of retinopathy really starts to go up."

He cautioned that there is no hard line between diabetes and normoglycemia, however, "...an A1C level of 6.5% is sufficiently sensitive and specific to identify people who have diabetes."

"We support the conclusion of the committee, that this is an appropriate way to diagnose diabetes," stated Paul Robertson, MD, president of medicine and science at the ADA and professor of medicine at the University of Washington in Seattle.

"Now, we have to refer the committee's findings to practice groups for review of the implications and for recommendations," Dr. Robertson told Medscape Diabetes & Endocrinology after the committee's presentation.

"We purposely avoided using estimated average glucose, or EAG, as this is just a way to convert the A1C into glucose levels.... And one thing we want to try to get away from is the term prediabetes," Dr. Nathan said. "It suggests that people with it will go on to get diabetes, but that is not the case."

"We don't know if we will be diagnosing more patients with diabetes or less, with AIC," Dr. Nathan commented. Cut-off values or practice guidelines have not been established. More study needs to be done first, but "physicians should not mix and match A1C and blood glucose levels. They should stick with one in reviewing a patient's history," Dr. Nathan asserted.

"There is no gold standard assay," said session moderator Richard Kahn, PhD, chief medical and scientific officer of the ADA, which is headquartered in Alexandria, Virginia. "All of these tests measure different things. They all have value. But A1C is the best test to assess risk of retinopathy."

"We [the ADA] are not issuing a position statement at this time," Dr. Robertson stressed when speaking withMedscape Diabetes & Endocrinology. "It is too soon to write a position paper yet. We need to know what we are getting into first."

"Some parts of the world are not going to be able to use this," Dr. Robertson added. "It may be too expensive to use in the developing world. Some of these countries have severe chronic anemia, hemolytic anemia, and so on, where we will have to fall back on traditional tests. We are being very cognizant of the international implications." A1C assays are inaccurate in cases of severely low hemoglobin levels.

"We don't think physicians will have a hard time adopting the test...a lot of them are doing it already. We think it will only take a couple of years to be adopted widely into clinical practice," Dr. Kahn told Medscape Diabetes & Endocrinology. "Physicians won't be shocked by this report, but patients — and insurance companies — might be. There are wider social issues that haven't been looked at yet."

None of the speakers at this session disclosed any relevant financial relationships.

American Diabetes Association (ADA) 69th Scientific Sessions. Presented June 5, 2009.

Diabetes Care. Published online June 5, 2009.

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