{"id":92436,"date":"2020-07-17T08:14:51","date_gmt":"2020-07-17T08:14:51","guid":{"rendered":"https:\/\/raed.academy\/?p=92436"},"modified":"2021-02-10T16:53:47","modified_gmt":"2021-02-10T16:53:47","slug":"un-sistema-no-invasiu-per-intervenir-la-prostata","status":"publish","type":"post","link":"https:\/\/raed.academy\/ca\/un-sistema-no-invasiu-per-intervenir-la-prostata\/","title":{"rendered":"Un sistema no invasiu per intervenir la pr\u00f2stata"},"content":{"rendered":"

Joaquim Gironella<\/em><\/strong><\/a>
\nCo-director m\u00e8dic de Laser Medical Rent i acad\u00e8mic de n\u00famero de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914 (RAED)<\/em><\/p>\n

Joaquim Gironella<\/strong>, reconegut ur\u00f2leg, co-director m\u00e8dic del centre Laser Medical Rent<\/strong> i acad\u00e8mic de n\u00famero de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914<\/strong> (RAED), presenta a la comunitat cient\u00edfica de la RAED en aquest article d’una forma did\u00e0ctica i rigorosa els \u00faltims aven\u00e7os en el tractament de la hiperpl\u00e0sia benigna de pr\u00f2stata (HBP) amb noves t\u00e8cniques no invasives com el revolucionari sistema d’alta freq\u00fc\u00e8ncia i vapor d’aigua Rezum<\/strong>.<\/p>\n

Tractament m\u00ednimament invasiu de la pr\u00f2stata sense anest\u00e8sia<\/h3>\n
\"Dr.

Dr. Joaquim Gironella<\/p><\/div>\n

Biol\u00f2gicament, l’envelliment de l’home i de la dona s’inicia principalment per l’aparell reproductor. En tots dos, anat\u00f2micament, el sistema genital \u00e9s ve\u00ed amb l’aparell urinari. En l’home m\u00e9s, la uretra travessa longitudinalment la gl\u00e0ndula sexual prost\u00e0tica situada per sota de la bufeta, de manera que l’aparici\u00f3 de s\u00edmptomes urinaris \u00e9s freq\u00fcent amb l’augment de l’edat biol\u00f2gica.<\/p>\n

Des d’aquesta perspectiva, en el g\u00e8nere mascul\u00ed, la coincid\u00e8ncia d’\u00f2rgans compartits de l’aparell reproductor amb l’urinari i m\u00e9s concretament amb la pr\u00f2stata li confereix a aquesta un especial rellev\u00e0ncia. Fet que ens porta a la sospita que l’envelliment en l’home comen\u00e7a amb el desenvolupament natural de la gl\u00e0ndula prost\u00e0tica a partir dels 40-45 anys. Amb el temps un percentatge elevat d’homes evolucionar\u00e0 cap a un creixement hiperpl\u00e0sic de la pr\u00f2stata, i sovint, amb un component obstructiu del flux urinari que pot anar associat amb disfunci\u00f3 sexual.<\/p>\n

Efectivament, l’edat de l’home \u00e9s un factor de risc en patologia prost\u00e0tica podent presentar el 50% dels homes s\u00edmptomes a partir dels cinquanta anys. Als 80 anys d’edat el 80% dels homes presenten algun grau d’hiperpl\u00e0sia prost\u00e0tica amb comprom\u00eds miccional. Feli\u00e7ment, el tractament de la hipertr\u00f2fia prost\u00e0tica ha anat evolucionant fins a l’actualitat on \u00e9s possible realitzar ter\u00e0pies quir\u00fargiques endosc\u00f2piques minimalistes: nom\u00e9s amb analg\u00e8sia i, aquest \u00e9s el gran avan\u00e7, a la mateixa consulta de l’especialista.<\/p>\n

Efectivament, la gesti\u00f3 dels s\u00edmptomes de la hiperpl\u00e0sia benigna de pr\u00f2stata (HBP) ha evolucionat cap a l’atractiva opci\u00f3 de les ter\u00e0pies ambulat\u00f2ries m\u00ednimament invasives amb tecnologia ablativa. Aquesta atraient opci\u00f3 per als homes inclouria la millora dels s\u00edmptomes urinaris i l’abs\u00e8ncia d’aparici\u00f3 d’efectes adversos sobre la sexualitat. Si a aix\u00f2 afegim una curta sessi\u00f3 de tractament sense entrar al quir\u00f2fan i el retorn normal a les activitats en poques hores, estem acostant-nos a la prescripci\u00f3 d’una ter\u00e0pia adequada a la realitat social i tecnol\u00f2gica dels nostres dies.<\/p>\n

L’\u00fas de l’ablaci\u00f3 en medicina no \u00e9s un fenomen nou. L’objectiu de destruir el teixit an\u00f2mal sense haver de tallar ha estat utilitzat \u00e0mpliament en cardiologia, dermatologia, ginecologia i en neurocirurgia durant d\u00e8cades. La utilitzaci\u00f3 de l’ablaci\u00f3 en urologia ha anat incrementant-se amb el pas el temps usant energia d’altres fonts com la criocirurgia i els ultrasons d’alta intensitat per al c\u00e0ncer de pr\u00f2stata.<\/p>\n

En el cas de l’HBP diversos procediments d’ablaci\u00f3 (TUNA) han estat avaluats des de principis del 1990. No obstant aix\u00f2 es van produir elevats r\u00e0tios de retractament i persistents s\u00edmptomes irritatius en el postoperatori immediat, el que va fer declinar l’\u00fas d’aquestes t\u00e8cniques. La injecci\u00f3 de vapor d’aigua amb el sistema d’alta freq\u00fc\u00e8ncia Rezum on s’injecta a vapor d’aigua a 105\u00ba ha suposat un pas important en la resoluci\u00f3 ponderada sota visi\u00f3 del component obstructiu de la pr\u00f2stata engrandida.<\/p>\n

Aquest vapor \u00e9s capa\u00e7 de destruir selectivament el teixit prost\u00e0tic mitjan\u00e7ant un proc\u00e9s convectiu, \u00e9s a dir, amb la transfer\u00e8ncia o transport de calor amb el moviment d’un fluid. El vapor \u00e9s uniformement dispersat a baixa pressi\u00f3 a la zona de la gl\u00e0ndula prost\u00e0tica que pr\u00e8viament hem injectat amb un determinat volum d’aigua. Aquesta ter\u00e0pia termal amb vapor d’aigua administrada dosi dirigides i controlades de calor emmagatzemada en vapor d’aigua es distribueix per convecci\u00f3 a la regi\u00f3 obstructiva de la pr\u00f2stata causant dels s\u00edmptomes i la incomoditat miccional del pacient.<\/p>\n

\"HiperplasiaCada tractament de 9 segons sobre un total de cinc o sis fa servir 0,42 ml de vapor d’aigua que es dispersa r\u00e0pida i uniformement a trav\u00e9s dels intersticis del teixit. La condensaci\u00f3 de vapor d’aigua allibera energia te\u00f2rica emmagatzemada. Les membranes cel\u00b7lulars es desnaturalitzen, produint-se aix\u00ed la mort cel\u00b7lular immediata i el tancament dels vasos sanguinis. Al mateix temps, es produeix una denervaci\u00f3 dels nervis alfa-adren\u00e8rgics de la zona, el que proporciona un tractament uniforme i predictible.<\/p>\n

Amb el temps aquest teixit t\u00e8rmicament desnaturalitzat \u00e9s reabsorbit de forma natural per l’organisme, reduint aix\u00ed el volum prot\u00e1tico i permetent que el conducte uretral s’obri alleujant els s\u00edmptomes urinaris. La ter\u00e0pia termal amb Rezum \u00e9s l’opci\u00f3 avui en dia id\u00f2nia per als home de m\u00e9s de 50 anys que ha optat per no prendre medicaments per a la seva disconfort urinari secundari a el creixement de la gl\u00e0ndula prost\u00e0tica, o b\u00e9 que els estan prenent per\u00f2 no estan satisfets. Tamb\u00e9 \u00e9s l’elecci\u00f3 preferent per als homes que no s\u00f3n candidats a procediments quir\u00fargics convencionals per a l’HBP, i especialment per als subjectes que no poden rebre anest\u00e8sia general o s\u00f3n d’alt risc.<\/p>\n

El gran valor afegit de la ter\u00e0pia termal amb vapor d’aigua \u00e9s la preservaci\u00f3 de la funci\u00f3 sexual en el 98% dels casos tractats. Efectivament, la preservaci\u00f3 de l’ejaculaci\u00f3 i de l’erecci\u00f3 confereix a aquesta ter\u00e0pia endosc\u00f2pica com l’elecci\u00f3 de prefer\u00e8ncia de molts pacients que volen preservar la integritat de les seves funcions sexuals.<\/p>\n

El tractament termal amb aigua -Rezum- de la simptomatologia prost\u00e0tica ha significat per a molts homes la possibilitat de recuperar el benestar miccional d’una manera r\u00e0pida, efectiva i senzilla alhora. El procediment ha estat una opci\u00f3 terap\u00e8utica a Su\u00e8cia i als Estats Units des de fa m\u00e9s de cinc anys amb estudis prospectius aleatoritzats que ha demostrat la utilitat de la t\u00e8cnica, la durada dels seus resultats i la preservaci\u00f3 de la funci\u00f3 sexual.<\/p>\n

    \n
  • Millora de l’IPSS 10,1 (46,7%).<\/li>\n
  • Millora de l’cabal + 4,2 ml \/ s.<\/li>\n
  • Retractament als cinc anys: 4,4%.<\/li>\n<\/ul>\n

    En el nostre grup de la Unitat Multidisciplin\u00e0ria d’Urologia L\u00e0ser Medical Rent<\/strong> vam fer a Barcelona el 21 de novembre del 2019 la primera cirurgia prost\u00e0tica ambulat\u00f2ria en consulta amb analg\u00e8sia\u00a0 (sense anest\u00e8sia) d’Espanya amb un elaborat protocol log\u00edstic i suport tecnol\u00f2gic. En l’actualitat, es fan mensualment diverses intervencions ambulat\u00f2ries en consulta amb ter\u00e0pia termal a pacients que acudeixen de diversos pa\u00efsos o ciutats tornant a les poques hores a les seves destinacions.<\/p>\n

    En resum:<\/p>\n

      \n
    • \u00c9s una ter\u00e0pia alternativa als medicaments per a l’HBP.<\/li>\n
    • A la majoria dels pacients s’observa una millora dels s\u00edmptomes en un termini de dues setmanes.<\/li>\n
    • No requereix anest\u00e8sia general ni espinal.<\/li>\n
    • Preserva la funcions sexuals i urin\u00e0ries.<\/li>\n
    • Permet als pacients reprendre l’activitat quotidiana en q\u00fcesti\u00f3 d’hores.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

      Joaquim Gironella presenta els \u00faltims aven\u00e7os en el tractament de la hiperpl\u00e0sia benigna de pr\u00f2stata (HBP) amb noves t\u00e8cniques no invasives<\/p>\n","protected":false},"author":12,"featured_media":92447,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[213],"tags":[],"class_list":["post-92436","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicina-i-cirurgia","et-has-post-format-content","et_post_format-et-post-format-standard"],"yoast_head":"\nUn sistema no invasiu per intervenir la pr\u00f2stata - Reial Acad\u00e8mia Europea de Doctors<\/title>\n<meta name=\"description\" content=\"Joaquim Gironella presenta els \u00faltims aven\u00e7os en el tractament de la hiperpl\u00e0sia benigna de pr\u00f2stata (HBP) amb noves t\u00e8cniques no invasives\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/raed.academy\/ca\/un-sistema-no-invasiu-per-intervenir-la-prostata\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Un sistema no invasiu per intervenir la pr\u00f2stata - 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