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What are kidney stones?

Kidney stones are deposits of minerals that crystallize in the urine when they become highly concentrated.

Kidney stones are created when there is a buildup of crystals in the urine. The stones sometimes pass through the ureter, but can also lodge in the kidney. When they block the ureter they can cause a backup of urine, which can lead to extreme pain.

The risk factors

Risk factors can include a family history of kidney stones, obesity, digestive disease, diets high in protein, sodium, and sugar, and dehydration. Diseases such as hyperparathyroidism, renal tubular acidosis and cysinuria can also be a contributing factor.


  • Severe pain in the side and back, below the ribs
  • Pain on urination
  • Pink, red or brown urine
  • Nausea and vomiting
  • Fever and chills if an infection is present
  • Urinating small amounts of urine

What are calcium stones?

Most common type of kidney stones.

Most people flush extra calcium their bodies don’t use out in their urine.

Several metabolic disorders can increase the concentration of calcium in urine, as can some diets, high levels of vitamin D.

Can also result from intestinal bypass surgery.

Prostate biopsy

What is a prostate biopsy?
It is obtaining a small amount of prostate tissue with a needle. This tissue sample is analyzed under the microscope in order to make a diagnosis.

Who need this procedure?
It is recommended for those patients in whom there is suspicion of prostate cancer, either because they have an elevated prostate-specific antigen or because the digital rectal examn revealed a suspicious area in the prostate.

Who performs the biopsy?
The biopsy is performed by a urologist. The procedure also involves the use of an ultrasound to guide the needle to take the sample. The biopsy is typically performed under local anesthesia.

How many samples are needed for a diagnosis?
In the case of patients with tumors that are not palpable during rectal examination, an those in which there is only a suspicion of cancer because the prostate-specific antigen is high, the method of sextant biopsy is used. This involves taking six fragments from each of the two lobes (right and left), extracting 12 in total. In the cases where the prostatic biopsy is negative but the patient has an increasing level of prostate antigen in successive follow-up tests, a new biopsy is performed in which additional sample are taken from each lobe.




Extract from: Prostate Cancer: A Patient’s Guide

Kegel exercises

Arnold Kegel was the first to propose exercises of contraction and relaxation of the pelvic muscles as a means for the non-surgical treatment of urinary incontinence. Originally the intention was for the patient to do as many of the exercises as possible, up to 500 times a day. Many patients contracted other muscles in addition to the pelvic muscles. Over time, the way of performing these exercises has changed substantially. The intention is that the abdominal muscles and buttocks remain relaxed while contracting the pelvic muscles.

The frequency and intensity of the contractions has also changed to avid muscle fatigue. Additionally, berthing exercises are included to help improve the work of the muscles. The exercises are designed to work both the fast-twitch muscle fibers (forming the striated sphincter) and the slow-twitch (which form much of the pelvic muscles that provide support for the bladder and rectum).Today, these are also known as the pelvic floor exercises.

Exercises for the fast-twitch muscle fiber: these fibers are found mainly in the muscle that forms the urogenital diaphragm and external sphincter (both urethral and anal). They are important to prevent loss of urine when sneezing, coughing, or lifting.



Exercises for the slow-twitch muscle fibers: Slow-twitch fibers have more endurance than fast-twitch fibers, that is, they tire less quickly and, therefore, provide ongoing support to the pelvic organs. The pelvic floor muscled have mostly show-twitch fibers, which support both the bladder and the urethra in the best position ford continence.

While the exercise can be done in any position, it is recommended when the patient starts this therapy, to perform in it the supine (lying on the back) position with the legs semi-flexed, resting on a couple of pillows or sitting in a comfortable chair. This is for the purpose of keeping the abdominal muscles relaxed.

Each training program is designed according to the needs and possibilities of each patient, taking into account his activity level, time availability, work hours, cognitive level, etc.

Extract from Prostate Cancer: A patient’s guide.

#Prostatectomy Preparation Prior to Surgery and Aftercare


Ten days before surgery:

All treatment with Aspirin ® or other anticoagulants should be suspended (warfarin, Plavix ®, etc.). All of the preoperative examinations should be done: laboratory exams, chest X-ray, and cardiovascular evaluation. If diabetic, estop taking, tablets of the oral hypoglycemic type (Glibenclamide, Metformin, etc.) 48 h before surgery.

The day before surgery: Have a light breakfast at 9 am .Starting at noon; take one-half of a bottle (50 ml) of undiluted oral laxative (Fleet Fosfoda®) followed by several and unpleasant taste of the laxative. Three hours after taking the first dose, take the remaining half of Thais laxative, also followed by the sweetened drinks. This oral laxative, also followed by the sweeting drinks. This Boral laxative will cause increase bowel movements in order to clean the intestine for the day of the operation.

For supper, have clear liquids such as water, juice, or tea; consuming liquid is acceptable, if thirsty, until midnight. Antihypertensive drugs should not be suspended nor should the time they are habitually taken be altered. Even on the morning of the day of the surgery, this medication should be taken with a small quantity of water (just a sip).
Finally, pack luggage for the hospital stay: take comfortable pants with an elastic waist, a shirt with buttons (which can be opened in front), and a bathrobe.

The day of surgery:

A full fast all day is required. If necessary, take only the anty-hypertensive medication with a sip of water.

The first hours after surgery: In the first hours the patient might feel cold, as well as some paint at the incision sites. This is easily controlled with painkillers.

A very common feeling is the discomfort produced by the presence of the catheter inside the urethra of the patient; generally this is perceived as an irritation or an intermittent desire to urinate without being able to, but the sensation is, mild an transitory. This is a normal effect due to the surgery and catheter in the urethra and bladder. The feeling disappears completely after a few hours. Family members and person accompanying the patient play an important role in the first hours after the operation to help control anxiety. If more intense discomfort occurs, the medical personnel should be notified.

Extract from Prostate Cancer: A Patient’s Guide.

Complication of Radical Prostatectomy


Traditionally, this has been a greatly feared operation because of the complications and consequences associated; however, thanks to research in recent years, it has been posible to describe the anatomical details and exact location of the blood vessels and nerves that are responsable for both urinary continence and for the erection. Now that the anatomy of the region is known perfectly, the technique has evolved and surgery can be performed while respecting each of these important structures and minimizing the associated risks. These risks are inherent in the general condition of the patient and the surgical procedure itself. They can be classified into general and specific risks.

These are the same complications as for any other surgery, and include the following:

  • Allergic reactions
  • Infecion
  • Pumonary problems
  • Hemorrhage
  • Cardiovascular problems

These are the complications related to the specific surgery used in the treatment of prostate cancer.

  • Intestinal injury: this is the most dangerous of all; it consists of fecal material leaking into the abdominal cavity due to the opening of the colon or rectum during surgery. This complication is very rare.
  • Rectovesical fistula: this is a communication between the rectum and the location where the bladder was joined to the urethra.
  • Urinary incontinence: This is the involuntary loss of urine, requiring the use of diapers. Usually it is transient. The patient progressively notes his recovery. Generally, one year after surgery, 96% of the patients have restored urinary continence.
  • Erectile dysfunction: the difficulty to achieve and maintain erections, due to the loss of the blood vessels and nerves responsible for erection. The way the patient is affected depends on age and the condition of the erections before surgery, in addition to general health conditions and risk factors such as smoking, diabetes, and others having to do with the microcirculation in the penis.
  • Urethral stricture: narrowing of the urethra due to scaring. This can occur anywhere along the urethra, from the tip of the penis to the site where the urethra joins the bladder.

Extract from Prostate Cancer: A Patient’s Guide.




Prostatitis is an inflammation of the prostate that can be produced by various agents, principally bacterial infections. The diagnosis of prostatitis is complex and can be frustrating, both for the patient and for the pshysician, since in many cases the symptoms are non-specific and hard to control. There are several types of prostatitis, according to the symptoms and their origin.

Type I Prostatitis

This is an infection of the prostate appearing suddenly, that os, in an acute manner, caused by bacteria present in the urine. The patient may have burning pain while urinating, an increase in the frequency of urination, fever, pelvic pain, or urinary retention.

Type II Prostatitis

This refers to a long-standing prostate infection. It can be the consequence of acute prostatitis, generally seen in older patients and commonly caused by the same bacteria. In general, this infection only makes itlself known when it causes problems in urinating.

Type III Prostatitis

This type of prostatitis is also chronic, but it is not related to a bacterial infection. It could be described as chronic pelvic pain. This category represents more than 90% of the causes diagnoses as prostatitis.

The majority of the patients are younger than 50 years old and suffer from symptoms such as pain in genitals, pelvis, or perineum; discomfort while urinating; and, sometimes, sexual dysfunction, including pain after ejaculation.

Extract from Prostate Cancer: A Patient’s Guide.

Today in Los Angeles interview…


I share a free translation from the interview published by the newspaper Hoy Los Angeles in relation to the book ‘Don’t Fear the Finger’.

By Selena Rivera

For many men the idea of having a finger inside the rectum to palpate any lumps or abnormal growths on the prostate is a nightmare; for some, apart from how uncomfortable this might be, it also represents a “threat” to their virility.

However, early and regular check-ups could save their lives, according to the urologist René Sotelo from the health centers of the University of Southern California.

Prostate cancer is the second leading cause of death in males, behind lung cancer. According to the American Cancer Society about one man in 38 will die from this disease.

A glandular organ that lies below the bladder and in front of the rectum produces semen.

“Prostate cancer, as any other cancer, is the uncontrolled growth of the cells of the body” Dr. Sotelo states.

Symptoms include frequent urination, weak or interrupted urine flow or pain while urinating, painful ejaculation, blood in the urine or semen, or an uncomfortable pain in the back, hip or pelvis. Nonetheless, these symptoms may also be signs of other diseases.

In many cases there are no symptoms in the early stages of the cancer. Besides, this disease may develop slowly”, Dr. Sotelo affirms.
That is why, it is necessary that, starting at age 50, all men begin to have a digital rectal exam.

“This exam allows a doctor to detect lumps or abnormalities. Unfortunately, for many men in our society this is a taboo subject; while others do not go to the doctor for fear of the result. This causes that many patients go to the doctor when the disease is in its advanced stages”, Dr. Sotelo states.

Today, a patient can also have a blood test that measures the level of a protein produced by the prostate. Higher than expected levels of this protein may mean that a tumor is present; it can also be a sign of an infection or an enlargement of the glandular organ.

The exact causes of prostate cancer are not known. Risk factors include family history and diet in men who eat large amounts of animal fat, he says.

“Likewise, it has been reported that the incidence of cancer is higher in countries with hotter weather”, Dr. Sotelo explains.
Prostate cancer may be a serious disease; however the majority of men diagnosed with prostate cancer do not die from this disease if it is treated in time, according to the American Cancer Society (ACS).

Other good news is that nowadays there are several treatments that may help patients, depending on their age and the stage of their cancer. “The key is that you ‘Don’t Fear the Finger’ and visit your doctor”, Dr. Sotelo, who wrote a book with this title, stresses.
Other facts found by the ACS:

About 220,800 new cases of prostate cancer were diagnosed in the United States in 2015.

About 27,540 deaths from prostate cancer were reported during 2015.

About 1 man in 7 will be diagnosed with prostate cancer during his lifetime.

Prostate cancer develops mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40.

Original article available at Hoy Los Angeles.

Today in Los Angeles interview…


I am grateful for the attention given in Hoy Los Angeles. My training is 100% Venezuelan. I share a free translation from the published interview:

By Selena Rivera

During his teenage years, René Sotelo was laughed at by his classmates because he was always wearing his lab coat. Back then, young Sotelo felt the calling to medicine as he began to take an interest in the body’s functions and its healing.

Decades later, the native of Venezuela became a pioneer in the handling of the robot in prostate and other diseases surgeries, thus being the first urologist to use this technique in Venezuela. This process was already being practiced in Mexico; however, it ceased after some surgical interventions because of “administrative issues”, Dr. Sotelo explains.

Since then, Venezuela took the lead with Sotelo at the forefront who took the leading position as regards the number of robotic surgeries performed in Latin America.

Then, his skills and futuristic methods have brought him to the renowned Hospital of the University of Southern California (USC) thanks to a job offer, through which he also obtained an extraordinary ability visa and a five year visa.

“I’ve been working at the USC for six months. I think that I was chosen because of my curriculum and my experience”, Dr. Sotelo says.
Just a quick look at the doctor’s resume is enough to notice it. His expertise in advanced robotic and laparoscopic surgery surpasses 2,300 cases which makes him one of the world’s most experienced professionals in this field. In addition, Dr. Sotelo has published more than 50 scientific articles, three textbooks and 28 book chapters about urology.

In recognition of his work, Dr. Sotelo has been invited as a lecturer to more than 35 universities, and he has shared his techniques in 19 countries. So far, he has trained more than 64 colleagues from 14 countries in the art and science of minimally invasive urology and robotic surgery.

He points out that he never thought he would get that far, since he studied in Venezuela and because of his humble startup.

“Mi mother was a school teacher and my father, a Mexican national, was a lithographer… from an early age they taught me to work hard; I witnessed how my parents worked overtime and at nights to pay for my studies”, he reveals.

Some time after, Dr. Sotelo worked for a clinic where he was more than welcomed and where he developed his talent. In 1992, young Sotelo graduated from the Central University of Venezuela, Hospital General del Este.

“I had no choice. I couldn’t afford to buy my own clinic. Over the years, I saw how the parents of some of my colleagues bought them their own clinics even when they didn’t graduate. However, it wasn’t my case”, he adds.

Nevertheless, he refined his techniques exceeding the medical community’s expectations. For this reason, he started to teach his skills abroad.

Based on laparoscopic surgery, robotic or minimally invasive surgery broadens its reach trough a four-armed robot and its 3D vision system.
This robot allows, therefore, the doctor to do the surgery with more precise movements as well as the possibility of preserving and restoring the patient’s anatomy.

Five years ago, it was imperative to remove the kidney affected by cancer. Nowadays, with this intervention only the tumor is removed, preserving the organ.

Dr. Sotelo adds that “these kinds of interventions are applied in the field of Urology, especially with regard to prostate, bladder and gynecological issues; it is also employed in cardiovascular, thoracic and valve replacement surgeries, and in general in surgeries requiring tissue reconstruction.”

For the young immigrant, living in a country that is new for him and his family is a challenge. Nevertheless, Dr. Sotelo is glad to represent the Latinos, to have the opportunity to use the advanced technology that is available in the United Stated, and to show the new generation of postgraduate medical students that with dedication and tenacity everything is possible.

Original article available here.