In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.
To establish the long-term efficacy and safety of bladder augmentation in spina bifida patients. Material and Methods: Sixteen patients were operated on using the Bramble technique. Preoperative and postoperative evaluation included clinical history, blood tests, urine cultures, cystography, pyelography, ultrasound, and filling cystometry. In the final review a standardized quality of life questionnaire was applied. Results: Median follow-up was 20 years (15-26). Kidney function was stabilized except for one case that required a kidney transplant. Hydronephrosis disappeared or improved (p = 0.03). Vesicoureteral reflux grades I-II was cured without reimplantation and grades III-IV responded better with reimplantation than without (p = 0.03). Quality of life improved in all patients, with all stating they would undergo the procedure again. After surgery, 94% of the patients exhibited diurnal continence but 25% exhibited nocturnal incontinence. Pressure at capacity decreased and bladder capacity increased (p < 0.001). One patient presented ureteral fistula with another presenting hemorrhage. Both required immediate surgical review. Late complications included urinary sphincter cuff erosion, renal lithiasis, four instances of bladder lithiasis and repeated pyelonephritis in one 24-year-old patient. All required surgery. The mean of urinary infections fell, from 2.5 per year (0.7) to 1 (0.5) (p = 0.03). Conclusion:Augmentation cystoplasty (AC) maintains its efficacy and improves quality of life in the long term. However, serious surgical complications can ensue, along with minor or major subsequent complications. This should be considered before surgery and makes lifelong monitoring of patients necessary.
The aim was to study the efficacy and tolerance in patients with haemorrhagic radiation-induced cystitis (HRC) treated with hyperbaric oxygen therapy (HOT) and analyze which factors were related to the response to the treatment. Material and methods: We performed a retrospective cohort study of patients treated with HOT for HRC symptoms in a provincial referral centre from 2010 to 2020. We evaluated clinical response to treatment, number of hospitalizations due to HRC and subjective response using the PGI-I questionnaire. Results: We treated 52 patients, with a median of 30 sessions, during 6 months and 40 months (6-68 months) of follow-up. 69.2% of patients responded completely and 21,2% partially. The 53.2% of patients improved before the first 10 sessions. Reduction of hospitalizations/per year due to haematuria from 2.8 to 1.1 (p=0,001). The 73,5% of patients stated that they were "very much better" or "much better" after treatment. During the follow-up, 15.4% of patients had recurrence of HRC. 9.6% of the patients required salvage cystectomy. The patients with a highest RTOG-EORTC scale had more risk to still with symptoms (OR 3.01 (IC95 1.48 -6.16). All patients were able to complete the proposed treatment plan with good tolerance to HOT. Conclusions: These results show the clinical benefit of HOT in the treatment of HRC, with a reduction of the number of hospitalizations and a subjective improvement. Resumen:Objetivo: conocer eficacia y tolerancia de la hiperoxigemia en cámara hiperbárica (THO) en pacientes con cistitis rádica hemorrágica (CRH) y analizar factores asociados a respuesta al tratamiento. Material y métodos: estudio de cohorte retrospectivo de pacientes tratados mediante THO por CRH en centro de referencia entre 2010 y 2020. Evaluamos respuesta clínica de la hematuria, número de ingresos hospitalarios por CRH y satisfacción subjetiva mediante cuestionario PGI-I. Resultados: tratamos 52 pacientes, mediana de 30 sesiones con 6 meses de tratamiento y 40 meses (6-68 meses) de seguimiento. El 69,2% obtuvo respuesta completa y el 21,2% respuesta parcial. El 53,2% mejoró antes de las 10 primeras sesiones. La reducción de los ingresos hospitalarios/año por hematuria fue de 2,8 a 1,1 (p=0,001). El 73,5% de pacientes señaló encontrarse "Mucho mejor" o "un poco mejor" tras el tratamiento. Durante el seguimiento, el 15,4% presentaron recurrencia de hematuria. Del total de la serie, 9,6% de pacientes precisó cistectomía de rescate. El análisis de supervivencia mostró una asociación entre el tiempo de desaparición de la hematuria y la clasificación de la escala RTOG-EORTC (OR 3,01 (IC95 1,48-6,16). Todos los pacientes pudieron finalizar el plan de tratamiento propuesto con buena tolerancia a la THO. Conclusiones: la THO muestra beneficio clínico en el tratamiento de la CRH, redujo los episodios de hospitalización por hematuria y mejoró la calidad de vida de los pacientes, con buena tolerancia al tratamiento.
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