[Assessment of the impact of pulmonary rehabilitation on sexual activity in patients with chronic obstructive pulmonary disease]

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) affects life quality, and also sexual activity. Pulmonary rehabilitation (PR) is a helpful treatment in COPD patients. The aim of this study is to assess sexual activity on COPD patients, and the effect of PR over it.

PATIENTS AND METHODS

Single cohort prospective study over male COPD candidates to PR. Clinical, respiratory and biochemical assessment (FSH, LH, T, and progesterone) was performed. Patients were asked to fill baseline International Index of Erectile Function (IIEF) questionnaire, and 6 months after PR. A descriptive initial analysis compared respiratory values between patients with and without sexual activity. Changes in IIEF results were assessed after PR, and satisfaction with treatment using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).

RESULTS

Between 2014 and 2016, 62 male COPD patients enlisted. Mean age: 66.5 years (SD 7.2). 52 Ex-smokers. 10 declared being sexually active (16.1%). No hormonal levels alterations. No significant differences on respiratory parameters between sexually active and non-active patients (FEV1, 6-minutes walking test, number of exacerbations, CAT score). Baseline mean IIEF values: Erectile function 8, orgasmic function 4, sexual desire 5.6, intercourse satisfaction 5.3, and overall satisfaction 4.5. After PR, significant increase in mean IIEF value: 6.1 (CI95% 1.9-10.3). Improvement was found in all domains, with statistical significance on intercourse satisfaction 0.9 (CI95% 0.2-1.6). Moderate satisfaction with treatment was achieved according to EDITS.

CONCLUSIONS

Only a low percentage of COPD males included in PR is sexually active. No pulmonary differences were found between sexually active and non-active patients. PR improves sexual function, particularly intercourse satisfaction domain.

[Zinner`s syndrome in a polytrauma patient.]

OBJECTIVE

To report two Zinner`s syndrome cases, a rare anatomical variant with risk of complications.

METHODS

Analysis of two Zinner syndrome cases, detected during acute recurrent epididimytis and after a grade IV renal trauma. Review of the literature focusing on its diagnosis and possible complications.

RESULTS

The conservative management of the polytrauma patient allowed to preserve the kidney, while maintaining normal renal function. It is the first Zinner`s syndrome diagnosed in this clinical context.

CONCLUSIONS

Zinner`s syndrome is a rare entity and often goes unnoticed because of the few symptoms it produces.

[Management of vesicourethral anastomotic stenosis after radical prostatectomy]

Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions.

[Mondor's disease vs. sclerosing lymphangitis of the penis]

OBJECTIVE

Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies.

METHOD

Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported.

RESULTS

Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes.

CONCLUSIONS

Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

Vasovasostomía: Nuestra experiencia

OBJECTIVES

From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples.

METHODS

The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others.

RESULTS

Overall spermatozoid potency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results.

CONCLUSIONS

Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the potency rate. Regarding pregnancy rate, it is not influenced by delay of reversal.

[Surgical details and complications from retransplantation into the iliac fossa for third and fourth kidney transplants]

OBJECTIVES

To analyze the surgical aspects and complications from retransplantation into the iliac fossa for third and fourth kidney transplants.

METHODS

Retrospective study of the 34 third and 5 fourth transplants performed in our department. We analyze patient's characteristics, surgical aspects and complications, and graft outcomes.

RESULTS

Mean patient age was 41.6 years. 67% of the first and second transplants had been lost to vascular problems (19%) or chronic rejection (48%). Average time from last transplant in the retransplanted iliac fossa was 9 years (3 days-17 years). There were not significant differences between the groups of first and second transplant and third and fourth in cold ischemia time, number of mismatches, and number of days on hemodialysis after transplantation; there were significant differences in receptor age, number of transfusions, maximum and current antibodies and donor age, all of which were higher in third and fourth transplants. The graft was basically implanted in the right iliac fossa (71%) through a lumbar-iliac iterative incision; vascular anastomosis were equally made to the common and external iliac vessels; ureteral reimplant was performed following an extravesical technique; simultaneous transplant nephrectomy of the previous graft was performed in 33% of the cases. 59% of the cases had immediate diuresis and 49% did not require dialysis within the first 7 postransplant days. Surgical complications were mainly vascular: 4 cases of hemorrhage, 3 venous thrombosis and 2 arterial thrombosis. There were also 4 cases of lymphocele, 1 perirenal hematoma, and 1 enterocutaneous fistula with an abscess of the surgical bed. There were no urologic complications in the series. Globally, there was 1 death (2.5%) secondary to hemorrhage and another 6 grafts (15%) were lost to complications, 5 vascular thrombosis and 1 after surgical bed abscess. 1, 3, 5, and ten-year actuarial graft survival were 65%, 52%, 40% and 28% respectively.

CONCLUSIONS

Retransplantation into the iliac fossa for third and fourth transplants is associated with a small increase in the number of surgical complications, mainly vascular complications.