Serrano-Brambila EA, Camacho-Carvajal JC, Moreno-Aranda J, Martinez-Sanchez R

Idioma: Español
Referencias bibliográficas: 45
Paginas: 435-448
Archivo PDF: 573.31 Kb.

RESUMEN

El Urolume es una malla, tubular, entretejida, de alambre fino, para uso en la uretra. Se reportan los resultados clínicos y flujométricos en 10 pacientes con estenosis de uretra y 4 con hiperplasia prostática obstructiva. El estudio abarca un periodo de 7 años desde octubre de 1993 hasta junio de 2000. Todos los pacientes fueron evaluados antes y después de la aplicación de la prótesis y se siguieron periódicamente para evaluar el índice de sintomatología prostática, calidad de vida, pico de flujo máximo, tasa de flujo medio, volumen vaciado y orina residual. Los resultados en el grupo de pacientes con estenosis de uretra: El I-PSS disminuyó de 26.8 a 5.4 puntos, el Qmax aumentó de 8.24 a 16.12 mL/seg, el Vvac aumentó de 196.4 a 295.2 mL disminuyendo la Ores de 42.7 a 31.6 mL. A los 12 meses todos los pacientes presentaban una epitelización del 90%, sólo un paciente requirió extracción de la prótesis sin lesión del esfínter. En los pacientes con hiperplasia prostática obstructiva: El I-PSS disminuyó de 20.2 a 8 puntos, el Qmax aumentó de 6.95 a 14.5 mL/seg, el Vvac aumentó de 183.2 a 229 mL disminuyendo la Ores de 49 a 18.3 mL. Doce meses después de la colocación de la prótesis 2 pacientes presentaban epitelización mayor del 95%, otros 2 un 70%. No se han presentado problemas significativos de infección, migración, incontinencia o disfunción eréctil. El 80% de los pacientes ha presentado algunos síntomas irritativos (urgencia, frecuencia y disuria) por lo menos en el primer mes de su aplicación. Los resultados sugieren que la prótesis uretral Urolume puede ser un tratamiento efectivo a largo plazo en este tipo de pacientes.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra. In: Walsh P, Retik A, Vaughan E, Wein A, editors. Campbell’s Urology. Seventh Edition. WB Saunders Company; p 3341

2. Chapple CR, Rickards D, Milroy E. Permanently implanted urethral stents. Seminars in Interventional Radiology 1991;8:284-294.

3. Dhom G. Próstata. In: Doerr W, Seifert G, Springer editors. Spezielle pathologische Anatomie. chapt 21. p. 445, 1992

4. Peters CA, Walsh PC. The effect of nafarelin acetate, a luteinizing hormone-releasing hormone agonist, on benign prostatic hyperplasia. N Engl J Med 1987;317:599-604.

5. Caine M, Perlberg S, Gordon R. The treatment of benign prostatic hipertrophy with flutamide (SCH 13521): a placebo-controlled study. J Urol 1975; 144: 564

6. Donnell R, Leport H. Alpha-blockaed for benign prostatic hyperplasia. J Endourol 199;5:83.

7. Brooks JR, Berman C, Garnes D, Giltinan D, Gordon LR, Malatesta PF, et al. Prostatic effects induced in dogs by chronic or acute oral administration of 5-alfa-reductasa inhibitors. Prostate 1986;9:65.

8. Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, et al. The effect of finasteride in men with benign postatic hyperplasia. The Finasteride Study Group. N Engl J Med 1992;327:1185-1191.

9. Schweikert HU, Tunn UW. Effects of the aromatase inhibitor testolactona on human benign prostatic hyperplasia. Steroids 1987;50:191-200.

10. Sirls LT, Ganabath K, Zimmern PE, Roskamp DA, Wolde-Tsadik G, Leach GE. Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy. J Urol 1993;150:1615-1621.

11. Montorsi F, Galli L, Guazzoni G, Colombo R, Bulfamante G, Barbieri L, et al. Transurethral microwave hiperthermia for benign prostatic hyperplasia: Long term clinical, pathological and ultrastructural patterns. J Urol 1992;148:321.

12. Baert L, Ameye F, Willemen P, Vandenhove J, Lauweryns J, Astrahan M, et al. Transurethral microwave hyperthermia for benign prostatic hyperplasia: preliminary clinical and pathological results. J Urol 1990;144:1383-1387.

13. Reddy PK, Wasserman N, Castañeda F, Castañeda-Zuñiga WR. Balloon dilatation of the prostate for treatment of benign prostatic hyperplasia. Urol Clin North Am 1988;15:529.

14. Reddy PK. Balloon dilation of the prostate: principles and techniques. J Endourol 1991;5:93.1991.

15. Blute ML, Tomera KM, Hellerstein DK, McKiel CF Jr, Lynch JH, Regan JB, et al. Tranurethral microwave thermotherapy for management of benign prostatic hyperplasia: Results of the United States Prostatron Cooperative Study. J Urol 1993;150:1591-1596.

16. Costello Aj, Bowsher WG, Bolton DM, Braslis KG, Burt J. Laser ablation of the prostate in patients with benign prostatic hypertrophy. Br J Urol 1992;69:603-608.

17. McCullough DL, Roth RA, Babayan RK, Gordon JO, Reese JH, Crawford ED, et al. Transurethral ultrasound-guide laser-induced prostatectomy: National Human Cooperative Study results. J Urol 1993;150:1607-1611.

18. Mebust WK. Surgical management of benign prostatic obstruction. Urology 1988; 32 Suppl. 12-15

19. Doll HA. Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol 1992;147:1566.

20. Mebust WK., Holtgrewe HL, Cockett ATK, Peters PC. and Writing Committee. Transurethral prostatectomy: inmediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3.885 patients. J Urol 1989;141:243.

21. Oesterling JE. Urologic applications of a permanent, epithelializing urethral endoprosthesis. Urology 1993;41 Suppl 1:10-18.

22. Parikh AM, Milroy JG. A new technique for removal of the Urolume prostate stent. Br J Urol 1993;71:620.

23. Oesterling JE. Technique of transuretrhal incision of the prostate (TUIP) and placement of the prostatic UroLume endoprosthesis. Atlas, Urol Clin North Am 1994 (in press, November 1994)

24. Sigwart U, Puel J, Mirkovitch U, Joffre F. Kappenberger, L. Intravascular stents to prevent occlusion and reestenosis after transluminal angioplasty. N Engl J Med 1987;316:(12)701.

25. Becker GJ. Intravascular stents: General principles and status of lower extremity arterial aplications. Circulation 1991;83 Suppl. 1:1-122, 1-136.

26. Dick R, Gillams A, Dooley JS, Hobbs EF. Stainless steel mesh stents for biliary strictures. J Intervent Radiol 1989;4:95-98.

27. Oesterling JE. Urologic applications of a permanent epitheliazing urethral endoprothesis. Urology 1993;41 Suppl 1:10-18.

28. Williams G, Coulange C, Milroy EJ, Sarramon JP, Rubben H. The Urolume a permanently implanted prostatic stent for patients at high risk for surgery. Result from 5 collaborative centers. Br J Urol 1993;72:335-340.

29. Guazzoni G, Bergamaschi F, Montorsi F, Consonni P, Galli L, Matozzo V. Prostatic Urolume wallstent for benign prostatic hyperplasia patients at poor operative risk: Clinical, uroflowmetric and ultrasonographic patterns. J Urol 1993;150:1641-1647.

30. Guazzoni G, et al. A modified prostatic Urolume wallstent for healthy patients with syntomatic benign prostatic hiperplasia: A european multicenter study. Urology 1994;44:(3)364-370.

31. Anjum MI, Chari R, Shetty A, Keen M, Palmer JH. Long-term clinical results of quality of life after insertion of a self expanding flexible endourethral prosthesis. Br J Urol 1997;80:885-888.

32. Chapple CR, Milroy EJ, Rickards D. Permanently implanted urethral stent for prostatic obstruction in the unfit patient. Preliminary report. Br J Urol 1990;66:58.

33. Shaw PJR, Milroy EJG. Permanent external striated sphincter stents in patients with spinal injuries. Br J Urol 1990;66:297-302.

34. McInerney PD, Vanner TF, Harris SAB, Stephenson TP. Permanent urethtral stents for detrusor sphincter dyssynergia. Br J Urol 1991;67:291-294.

35. Fabian KM. Der intraprostatitische “Partielle Katheter” (Urologische Spirale). Urologe A 1980;19:236.

36. Morgenthaler A, DeWolf WC. A self-expanding prostatic stent for bladder outlet obstruction in high risk patients. J Urol 1993;150:1636.

37. Nordling J, Ovesen H, Poulsen AL. The intraprostatic spiral: clinical results in 150 consecutive patients. J Urol 1992;147:645.

38. Vicente J, Salvador J, Chéchile G. Spiral urethral prosthesis as an alternative to surgery in high risk patients with benign prostatic hyperplasia: Prospective study. J Urol 1989;142:1504.

39. Milroy EJG, Chapple CR, Cooper JE, Eldin A, Wallstent H. A new treatment for urethral strictures. Lancet 1988;1424-1427.

40. Williams G, Jaeger R, McLoughlin J. Prostatic stents: A new treatment for prostatic outflow obstruction in patients unfit for surgery. Br Med J 1989;298:1429.

41. Williams G, Coulange C, Milroy EJ, Sarramon JP, Rubben H. The Urolume a permanently implanted prostatic stent for patients at high risk for surgery. Result from 5 collaborative centers. Br J Urol 1993;72:335-340.

42. Oesterling J, Defalco A, Kaplan S, Reddy P, Epstein H, Chancellor M. and de North American Urolume study group. The North American experience with the Urolume endoprosthesis as a treatment for benign prostatic hiperplasia: Long term results. Urology 1994;44:(3)353-362.

43. Baldani GH, Press SM, Defalco A, Oesterling JE, Smith AD. and the north american urolume study group. Urolume endourethral prosthesis for the treatment of urethral stricture disease: Long-term results of the north american multicenter urolume trial. Urology 1995;45:846-856.

44. Ashken MH, Coulange C, Milroy EJ and Sarramon JP. European experience with the urethral wallstent for urethral strictures. Eur Urol 1991;19:181–185.

45. Bassi S, Puscinski A, Lata J, Netto NR, Lima M, Dávila H, Vargas J, López MA, Berkowski E, Moreno AJ, Garcia IC, Serrano BE, Vargas RD, Valdevenito R, Lucon AM, Mitre A, Freire GC, Arap S, Vaz F. The urolume endoprothesis as minimal invasive in the treatment of prostatic obstruction: the Latin American experience. American Urological Association Meeting 1997.