Computer vision-based system for early diagnosis of stereoscopic vision alterations.

Stereopsis is the three-dimensional perception capability, which is possible when binocular vision is present. Development of binocular vision system ends around 7-year-old, and after this time brain connections are already set, therefore, it will be difficult to recover stereopsis. Early diagnosis of Stereoscopic Visual Alterations (SVA) in the childhood is paramount to receive an appropriate treatment as soon as possible. Currently, to detect SVA, ophthalmologists commonly carry out tests based on cards. All these tests are based on the random-dot-stereogram principle, with different seconds of arc images, which allows doctors to graduate stereopsis. Some limits of this tests have been identified, such as monocular clues (e.g., the contours of the objects), or the non-standardized range levels depending on the test. This paper presents a novel concept of measuring stereopsis based on computer vision techniques. The system detects SVA in patients and calculates the degree of the perceived depth. As early diagnosis of SVA may suppose a therapeutic possibility, this platform is aimed at children by using stereoscopic models with varied and attractive designs. To validate the proposal, an early-stage prototype has been implemented and an objective evaluation of the measurement accuracy and reliability has been carried out with satisfactory results.

Oral quality of life after buccal mucosal graft harvest for substitution urethroplasty. More than a bite?

INTRODUCTION: The aim of our study was to analyze the oral quality of life (QoL) in patients with urethral stricture treated with BMG by using a validated questionnaire (OIDP). MATERIALS AND METHODS: A prospective, single-arm, observational single-centre study of a cohort of patients scheduled for BMG Urethroplasty was conducted. OIDP assesses the impact of oral conditions on daily activities including an oral QoL question (0-10). The questionnaire was self-administered before, 3 months postoperatively and at the end of the study. Means, pre- and postoperatively, were compared. Multivariate analysis was performed to analyze the risk factors for a low quality of life (<8) after surgery. RESULTS: We included 41 patients (2013-2017). The mean preoperative oral QoL was 9.33 points (SD1.16). Preoperative mean OIDP dimensional score and global score were 0,5 (SD:0.02) and 0,8%. The most frequently preoperative altered aspect was hygiene. Mean oral QoL, 3 months after surgery, was 8,56 (SD1.89) and OIDP dimensional score and global score were 0,67 (SD0.21) and 1,1%. Mean oral QoL at the end of the study (mean 3,12 years) was 8,50 (SD1.13). OIDP dimensional score and global score were 0,7 (SD 0.16) and 1,1%.The most frequently altered aspect at the end of the study was eating. No statistical (p = 0.07) decrease in oral QoL was found. The increase in OIDP dimensional and global score was also not statistically significant. Neither age nor smoking, diabetes mellitus, cardiovascular morbidity, previous OIDP score, width, length of the graft, or surgery success could explain a low oral QoL alter graft harvesting. CONCLUSIONS: BMG harvesting is not free of problems at the donor site. Eating seems to be the most affected aspect after surgery. Nevertheless, those sequelae do not induce a reduction in oral QoL.

Application of Lean Healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency. / Aplicación de la metodología Lean healthcare en un servicio de urología de un hospital terciario como herramienta de mejora de la eficiencia.

OBJECTIVE: To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. MATERIAL AND METHODS: The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: 1) team training and improvement of feedback among the practitioners, 2) management by process and superspecialisation and 3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. RESULTS: The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. CONCLUSIONS: The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology.

Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis. / Costes y procesos hospitalarios en un servicio de urología de un hospital terciario. Análisis de los grupos relacionados por el diagnóstico.

INTRODUCTION: The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. OBJECTIVE: The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. MATERIAL AND METHODS: From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). RESULTS: A total of 32,510 outpatient consultations, 7,527 techniques, 2,860 interventions and 4,855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. CONCLUSIONS: The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control.

The role of IGF-1 and the distribution of body fat in decreasing the number of prostate rebiopsies. / Papel del IGF-1 y la distribución de la grasa corporal para disminuir el número de rebiopsias prostáticas.

OBJECTIVE: To assess the usefulness of IGF-1 and internal organ fat measured by bioelectrical impedance audiometry to avoid rebiopsies in patients with persistently high prostate-specific antigen (PSA) levels. MATERIAL AND METHOD: A prospective study was conducted with 92 patients who underwent prostate rebiopsy due to high PSA levels with negative results in the rectal examination and a lack of preneoplastic lesions. The patients previously had their IGF-1 levels measured and had undergone an impedance audiometry test using the abdominal Fat Analyser AB-140 TANITA system. We calculated the receiver operating characteristic (ROC) curves for the PSA levels, %PSA, internal organ fat and IGF-1 and PSA density. RESULTS: Twenty-five patients were diagnosed with prostate cancer. These patients had significantly higher PSA, PSAd and IGF-1 values and a tendency towards higher internal organ fat levels and lower %PSA readings (p=.001, p=.003, p=.001, p=.24 and P=0.28, respectively). The ROC curve showed an area under the curve for IGF-1 and PSA of .82 and .81, respectively. Using the cutoff points for 95% sensitivity and using the 3 criteria as an indication of rebiopsy, 74% of the biopsies would have been spared, leaving undiagnosed only 1 patient with clinically significant cancer -Gleason score>7 (4+3)-. The positive and negative predictive values for the set of variables were higher than for each one separately (PPV: 66/NPV: 63). The cost of both determinations was 82 euros. CONCLUSIONS: Our results suggest that measuring IGF-1 could significantly decrease the number of unnecessary rebiopsies in an inexpensive and safe manner.

Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments. / Hidrodistensión bajo anestesia más inyección de Onabotulinumtoxin A en pacientes con síndrome de dolor vesical refractario a tratamiento conservador.

INTRODUCTION: For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique. MATERIAL AND METHODS: A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analogue scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal-Wallis, Kaplan-Meier and log-rank tests. RESULTS: We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; P=.001), in daytime (from 11.8 to 7.5; P=.012) and night-time (from 5.9 to 3.6; P=.003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points; P=.042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI 5.69-8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases. CONCLUSIONS: The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments.

ONCO-TESE: Obtaining spermatozoa after radical orchiectomy for testicular tumour and azoospermia.

OBJECTIVE: There is the possibility of diagnosing azoospermia in cases of testicular tumours in patients who wish to preserve fertility. Our objective is to present a technique for obtaining spermatozoa from testicles with ex vivo tumours in order to preserve fertility in these patients. MATERIAL AND METHODS: A 34-year-old patient was referred for azoospermia. The physical examination revealed a node in the lower pole of the left testicle. In the scrotal ultrasound, the testicle presented disperse microcalcifications and a 1-cm hypoechoic mass in the lower pole. The tumour markers were negative, and the CT showed no distant disease. Left radical orchiectomy was performed, along with the placement of a testis prosthesis. Bench surgery was then performed, with extraction of the seminiferous tubules in the upper pole. RESULTS: Of the submitted samples, 4 progressive and 1 nonprogressive motile spermatozoa were identified per field. Two samples were cryopreserved. The pathological report indicated the presence of a seminoma measuring 1.3 × 1 cm, with free margins and with no invasion of the rete testis (stage I). An assisted reproduction technique (intracytoplasmic sperm injection) was performed on the patient's partner with the frozen spermatozoa, which resulted in pregnancy and the subsequent birth of a healthy child. CONCLUSION: We propose this technique as the method of choice for obtaining spermatozoa from patients who simultaneously present azoospermia and testicular tumours and who wish to preserve their fertility.

AZF gene microdeletions: case series and literature review.

OBJECTIVE: Aproximately 10% of patients with non-obstructive azoospermia and 5% with non-obstructive severe oligozoospermia carry AZF region microdeletions (AZoospermic Factor) in the Y chromosome. The aim of this study is to analize the clinical and pathological findings in this group of patients and compare them with the previous evidence. MATERIAL AND METHODS: Retrospective study of 11 patients with diagnosis of azoospermia or oligozoospermia and the presence of AZFa, AZFb, AZFc microdeletions or any combination of them. RESULTS: Microdeletions of AZFc region were found in 45% of cases, AZFa in 33% and a 10% showed a deletion of the three regions (a,b and c). 91% of them demonstrated azoospermia with low testicular volume in 62,5% cases. CONCLUSION: Microdeletions of AZF regions are associated with azoospermia and a low expectation of sperm retrieval in testicular biopsy. On the other hand, they seem not related with significative modifications on the hormone profile.

[Phytotherapy in urology. Current scientific evidence of its application in urolithiasis, chronic pelvic pain, erectile dysfunction and urinary tract infections]. / Fitoterapia en Urología. Evidencia científica actual de su aplicación en urolitiasis, dolor pélvico crónico, disfunción eréctil e infecciones urinarias.

OBJECTIVE: To assess the usefulness of phytotherapy in urolitiasis, urinary tract infections, erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain (CP/CPP). ACQUISITION OF THE EVIDENCE: Systematic review of the evidence published until January 2011 using the following scientific terms:phytotherapy, urinary lithiasis, Chronic prostatitis, chronic pelvic pain, erectile dysfunction, urinary tract infection, cystitis and the scientific names of compounds following the rules of the International Code of Botanical Nomenclature. The databases used were Medline and The Cochrane Library.We included articles published until January 2011 written in English and Spanish. We included studies in Vitro/in vivo on animal models or human beings. Exclusion criteria were literature not in English and Spanish or articles with serious methodological flaws. SYNTHESIS OF THE EVIDENCE: We included 86 articles selecting 40 that met the inclusion criteria. In Urolitiasis there are few works in humans. The phytate has its main use as prevention and in reducing the growth of residual fragments after extracorporeal shock wave lithotripsy (ESWL). In CP/CPP the only compound that has shown effectiveness was the extract of pollen in a field of multimodal treatment. In DE ther is no evidence for the use of herbal medicine.Most of the works have limitations in the design or low sample size. In urinary tract infections most of the products are diuretics .There is only evidence for the cranberry as prevention in young or pregnant women. It must not be used as a treatment for urinary tract infections. CONCLUSIONS: Phytotherapy is usefull in repeat urinary tract infections and the CP/CPP. It has some role in the urolitiasis and lacks useful in the DE.

[Phytotherapy in urology. Current scientific evidence of its application in benign prostatic hyperplasia and prostate adenocarcinoma]. / Fitoterapia en Urología. Evidencia científica actual de su aplicación en hiperplasia benigna de próstata y adenocarcinoma de próstata.

OBJECTIVE: To evaluate the usefulness of phytotherapy in the treatment of the benign prostatic hyperplasia (BPH) and prostatic adenocarcinoma (ADCP). ACQUISITION OF EVIDENCE: Systematic review of the evidence published until January 2011 using the following scientific terms: phytotherapy, benign prostate hyperplasia, prostatic adenocarcinoma, prostate cancer and the scientific names of compounds following the rules of the International Code of Botanical Nomenclature. The databases used were Medline and The Cochrane Library. We included articles published until January 2011 written in English and Spanish. We included studies in vitro/in vivo on animal models or human beings. Exclusion criteria were literature not in English and Spanish or articles with serious methodological flaws. SYNTHESIS OF THE EVIDENCE: We included 65 articles of which 40 met the inclusion criteria. BPH: the most studied products are serenoa repens and pygeum africanum. There are many studies in favour of the use of phytotherapy but its conclusions are inconsistent due to the small number of patients, the lack of control with placebo or short follow-up. However the use of these products is common in our environment. ADCP: there is no evidence to recommend phytotherapy in the treatment of the ADCP. There are works on prevention but only at experimental level so there is no evidence for its recommendation. CONCLUSIONS: The scientific evidence on the use of phytotherapy in prostatic pathology is conclusive not recommend ing the use of it for BPH or the ADCP.

Ureteral avulsion as a complication of ureteroscopy

PURPOSE: Report and review the literature on ureteral avulsion as a rare complication of ureteroscopy. MATERIALS AND METHODS: We analyzed 3 cases of ureteral avulsion in a series of 4,645 ureteroscopic procedures performed from January 1990 to December 2001. We especially report the different managements for this complication. RESULTS: Due to the different extent of the injury, each patient was treated in a particular way, including a patient managed by means of an endourological approach. CONCLUSIONS: When performing ureteroscopy or using Dormia baskets, one should always bear in mind the possibility of serious complications, including ureteral avulsion or perforation. The use of an extremely careful technique of ureteral insertion, the mandatory placement of a safety guidewire, and a working guidewire, all minimize the risk of untoward events

Ureteral avulsion as a complication of ureteroscopy.

PURPOSE: Report and review the literature on ureteral avulsion as a rare complication of ureteroscopy. MATERIALS AND METHODS: We analyzed 3 cases of ureteral avulsion in a series of 4,645 ureteroscopic procedures performed from January 1990 to December 2001. We especially report the different managements for this complication. RESULTS: Due to the different extent of the injury, each patient was treated in a particular way, including a patient managed by means of an endourological approach. CONCLUSIONS: When performing ureteroscopy or using Dormia baskets, one should always bear in mind the possibility of serious complications, including ureteral avulsion or perforation. The use of an extremely careful technique of ureteral insertion, the mandatory placement of a safety guidewire, and a working guidewire, all minimize the risk of untoward events.

Paraureteral extrusion of calculi after endoscopic pulsed-dye laser lithotripsy.

Laser lithotripsy has become an effective and low-morbidity procedure for the treatment of ureteral calculi. Nevertheless, ureteral endoscopy is not free of side effects and complications. Lithiasis extrusion is one of the early complications of this procedure, and usually, the diagnosis is carried out by means of urographic findings because it is not easily recognized during ureteroscopy. Between January 1990 and May 1996, a total of 1047 endoscopic lithotripsies with the pulsed-dye laser were performed in our department. The 3-month stone-free rate as a single treatment was 76.5%. We found 11 cases (1.05%) of calculi extrusion after ureteral endoscopic treatment. Only one case was diagnosed intraoperatively. The evolution after a mean follow-up period of 18 months (range 6-34 months) was satisfactory in all cases. No urinary extravasation, infection, or secondary ureteral strictures were found. According to the absence of side effects, it was considered unnecessary to remove the extruded calculi. Extrusion of noninfected calculi into the periureteral tissues after laser lithotripsy causes no significant consequences and can be successfully managed conservatively. Knowledge of this possible complication is the best way to avoid it. A careful technique and a low irrigant flow will be very helpful.

[Combined endoscopic treatment with extracorporeal lithotripsy in chronic calcifying pancreatitis]. / Tratamiento endoscópico combinado con litotricia extracorpórea en la pancreatitis crónica calcificante.

In the management of severe chronic pancreatitis, a variety of new endoscopic methods have been proposed as an alternative to traditional surgery. The main goal of these procedures is the remission of pain. They include pancreatic endoscopic sphincterotomy with subsequent endoscopic extraction, which can be associated to extracorporeal shock-wave lithotripsy for stone desintegration before removal of large calculi, and to the insertion of a pancreatic stent in case of a pancreatic duct stricture. We present two cases of severe chronic pancreatitis managed successfully with this endoscopic treatment.

[Extracorporeal shockwave lithotripsy: an alternative treatment for lithiasis of caliceal diverticula]. / Litotricia extracorpórea por ondas de choque: una alternativa al tratamiento de las litiasis de divertículos caliciales.

Among all the patients treated in our Lithotrity Unit, 13 of them had lithiasis inside the calyceal diverticulum. They were all treated by extracorporeal shockwaves. In none of the cases complete expulsion of lithiasic mass was achieved. In 3 (23%) cases it was reduced to half. In 2 (15.3%), 75% of the initial mass remained; and in 8 (61.5%) stones were fragmented but none of their debris was eliminated. Out of all the patients who were symptomatic before starting treatment, only 36.6% become asymptomatic. Extracorporeal lithotrity is, therefore, an approach with limited results in the calyceal intradiverticular lithiasis.

[Abdominal echography to determine the weight of the prostate]. / La ecografía abdominal en la determinación del peso prostático.

The relationship of post-operatively determined prostatic gland weight and that calculated prior the procedure, by means of abdominal ultrasound techniques using the "ellipsoid method", has been studied in 88 patients undergoing retropubic adenectomy. The regression line was nearly optimal, Y = 0.946 X + 2.295, and the correlation coefficient between both weight measures was r = 0.915. Abdominal ultrasound examinations are a simple, quick and safe means to evaluate prostate weight, prior to deciding the type of surgery (open adenectomy or transurethral resection) for prostate adenoma.

Urological complications associated to uterus didelphys with unilateral hematocolpos. A case report and review of the literature.

Complete duplication of vagina, cervix and uterus, with imperforate hemivagina and renal agenesis is a rare condition with less than 120 cases published. In those articles, urological complications are uncommon with only a 10% of the total. We report 2 cases of uterus didelphys with unilateral hematocolpos and ipsilateral renal agenesis with urological clinical complications. One of them presented a very rare onset complaining of acute urinary retention. The other patient was referred for difficulty in micturition and abdominal pain which is the most common symptom of this entity. A description of both cases and a literature review of this congenital complex syndrome and its urological complications are reported.

Agenesis of seminal vesicles in infertile males: ultrasonic diagnosis.

We present the incidence of seminal vesicle agenesis and its association with deferens ductus agenesis in 141 males presenting with infertility. Transrectal ultrasonography was performed in every patient. Ten presented seminal vesicle agenesis (8 unilateral and 2 bilateral). Three had absence of the vas deferens on physical examination (3 of 7 with unilateral seminal vesicle agenesis and 1 of 2 with bilateral). Computed tomography confirmed the ultrasound findings. We emphasize the importance of the anomalies as a cause of infertility and the association with other genitourinary anomalies. Moreover, we state the necessity of transrectal ultrasound in the diagnosis.

Renal cell carcinoma: late recurrence in 2 cases.

We present 2 patients with late recurrence 16 and 11 years after nephrectomy for renal cell carcinoma. Metastases were solitary and their location very uncommon (vastus externo muscle and colon). In the reviewed series of 5,758 patients with renal cell carcinoma only a temporal muscle metastasis and another in the colon were observed but none of them was solitary.

[Perirenal hematoma caused by spontaneous upper calix rupture]. / Hematoma perirrenal por rotura espontánea calicial superior.

We report a case of perirenal hematoma from spontaneous rupture of the upper urinary tract associated with parenchymal rupture due to a calculus lodged in the pelvic ureter. The clinical features were pain confined to the renal fossa, leukocytosis and Hct of 36%. Diagnosis was made by percutaneous punction pyelography.