Using hyperrealistic simulations to improve digital informed consent for endourological procedures.

OBJECTIVES: To show that digital informed consent (DIC) improves the subjective understanding of information and, therefore, informed consent. PATIENTS AND METHODS: A nonblinded randomized controlled trial was performed in 84 patients who had undergone transurethral resection of bladder, transurethral resection of prostate, or ureterorenoscopy between July 2017 and March 2018. The DIC group watched a hyperrealistic simulation on a tablet device before surgery. After surgery and again 30 days later, both groups completed a validated questionnaire that measured subjective understanding, anxiety, and utility of and need for information. RESULTS: The mean ± SD age of the participants was 68.7 ± 11.1 years. Nine of 84 patients (10.7%) did not complete the questionnaire. A total of 42 patients were allocated to the DIC group and 42 to the control group. The mean ± SD score for immediate subjective understanding in the DIC group was 14.5% higher than in the control group (72% ± 17.5% vs 57.5% ± 23.5%, respectively; P = 0.006). There was no statistical difference in anxiety, utility of and need for information relative to delayed subjective understanding. In subgroup analysis, subjective understanding scores were higher, but not significantly so, among patients with low and higher education levels in the DIC group than in the control group (68% ± 18.1% vs 54% ± 22.5% [P = 0.06] and 76% ± 18.3% vs and 66% ± 21.9%, respectively [P = 0.89]). CONCLUSION: Hyperrealistic simulations improved subjective understanding of information and, therefore, informed consent for endourological procedures.

From open to robotic partial nephrectomy.

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease.

[Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor]. / Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal.

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate.

[Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness]. / Biología molecular en adenocarcinoma renal (RCC). Su utilidad pronóstica y terapéutica.

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomalies in renal adenocarcinoma with special emphasis in the Von HippelLindau gene.

[New technologies in partial nephrectomy]. / Nuevas tecnologías en la nefrectomía parcial.

OBJECTIVES: We aim to analyse the role of new technologies in management of small renal cancer. METHODS: We perform a non-systematic review of the literature in Medline, Cochrane Database of Systematic Reviews between period 2000-2012, using following mesh terms: partial nephrectomy, renal ablative technologies, and renal cancer. RESULTS: We don't review in this article ablative technologies such as cryotherapy, radiofrequency, as they are the subject of others manuscripts within this monographic issue. We focus on high intensity ultrasounds (HIFU) microwaves therapy, radiosurgery, laser and water jet dissection. CONCLUSIONS: New technologies in partial nephrectomy are under constant and vertiginous evolution. Although efficacy has been demonstrated in short term and isolated studies, more studies, better designed, with bigger sample size and longer follow up are needed.

Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system.

BACKGROUND: Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS: A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS: Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS: WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.

How does endorectal MRI, PET-CT and transrectal ultrasound contribute to diagnosis and management of localized prostate cancer.

We analyze the main imaging techniques (transrectal ultrasound, Magnetic Resonance Imaging and Position Emission Tomography) that are currently used in the diagnosis and management of localised prostate cancer patients. We analyze the results that may be obtained with transrectal US and describe the latest advances in this technique (Doppler, power doppler and contrast media). With Magnetic Resonance Imaging, we describe the underlying principles, results and indications as well as some new applications (diffusion, perfusion, spectroscopy and the use of lymphotrophic nanoparticles). Finally we will describe the current state of positron emission tomography in diagnosis, follow up and recurrence detection using the different radiomarkers that are available.

[Bladder leiomiosarcoma. A new case and a review of the literatura]. / Leiomiosarcoma vesical. Presentación de un nuevo caso y revisión de la literatura.

Bladder Leiomiosarcomas are exceptional mesenchimal tumours. Their differential diagnosis is basic to decide our therapeutic attitude. We present a new case of bladder leiomiosarcoma with a bad behavior and with multiple relapses, and perform a review of the literature in order to establish more properly the therapeutic attitudes.

[Usefulness of PET scans in diagnosing recurrent prostate cancer. Prostate with PSA level < 5 ng/ml]. / Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml.

INTRODUCTION AND OBJECTIVES: We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. MATERIAL AND METHODS: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-choline and 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 x 2 and 2 x X contingency tables and ROC curves. RESULTS: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=.003): the clinical stage (P=.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P< .0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET 18FDG: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 5.15 ng/ml. CONCLUSIONS: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment.

[Management of chylous fistulas, a rare complication after urologic surgery]. / Manejo de las fístulas de quilo, una rara complicación tras cirugía urológica.

OBJECTIVE: To analyze the different treatments for postoperative chylous fistulae. METHODS: A literature review of the main treatments for postoperative chylous fistula, providing our initial experience of two cases of patients with postsurgical chylorrea, with conservative treatment. RESULTS: There is very limited experience in the treatment of chylous ascites. According to the literature reviewed, Octreotide (somatostatin analogue) can be used, to decrease fistula output. Both our cases cases were treated successfully with subcutaneous octreotide, with drain debit decrease in about 3 days. CONCLUSIONS: The use of octreotide appears to be an effective treatment in the management of chylous fistulae, and it is suggested by some authors as first-line treatment in the management of these, thus decreasing the complications that can appear due to chyle loss.

Does Time and Size Matter in Retrograde Intrarenal Surgery? Results Analysis Using a Low-Pressure Technique

Purpose: Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the treatments of choice. We analyzed the results from our patients who underwent retrograde intrarenal surgery at controlled pressure. Materials and Methods: We conducted an observational, descriptive, retrospective study of 403 patients who underwent retrograde intrarenal surgery at the Hospital Clínico Universitario Lozano Blesa (Zaragoza, Spain) between January 2013 and December 2019. Results: The mean surgical time was 111.1 minutes, with a mean stone volume of 3.5 cm3 (maximum volume, 38.3 cm3). A total of 70 patients (17.3%) developed postoperative Clavien-Dindo complications—64 minor (91.4%) and 6 major (8.6%). In addition, 28 patients (6.9%) presented with an early complication (<3 months), with urinary tract infection and pyelonephritis being the most common. The stone-free rate was 69.0%, with a retreatment rate of 4.7%. Conclusions: Sex was statistically significantly related to the onset of minor Clavien postoperative complications (p = 0.001). Similarly, corticosteroid use was associated with the onset of major Clavien complications (p = 0.030). Neither surgical time nor stone volume was found to be statistically significantly related to the onset of Clavien postoperative complications or early complications (AU)

Manejo de las fístulas de quilo, una rara complicación tras cirugía urológica / Management of chylous fistulas, a rare complication after urologic surgery

OBJETIVO: Analizar los diferentes tratamientos para la fístula de quilo postoperatorias. MÉTODOS: Realizamos una revisión bibliográfica de los principales tratamientos para la fístula de quilo postoperatorias, aportando nuestra experiencia inicial de dos casos de pacientes con quilorrea postquirúrgica, con tratamiento conservador. RESULTADO: Existe muy poca experiencia del tratamiento de la ascitis quilosa, puede utilizarse, según la literatura revisada, el octreótide (análogo de la somatostatina), aportamos fueron tratados exitosamente con octreótide subcutáneo, disminuyendo el débito del drenaje en 3 días aproximadamente. CONCLUSIONES: El uso del octreótide aparece como un tratamiento efectivo en el manejo de las fístulas quilosas, y sugerido por algunos autores como tratamiento de primera línea en el manejo de estas, disminuyendo así las complicaciones que la pérdida de quilo puede conllevar

OBJECTIVE: To analyze the different treatments for postoperative chylous fistulae. METHODS: A literature review of the main treatments for postoperative chylous fistula, providing our initial experience of two cases of patients with postsurgical chylorrea, with conservative treatment. RESULTS: There is very limited experience in the treatment of chylous ascites. According to the literature reviewed, Octreotide (somatostatin analogue) can be used, to decrease fistula output. Both our cases cases were treated successfully with subcutaneous octreotide, with drain debit decrease in about 3 days. CONCLUSIONS: The use of octreotide appears to be an effective treatment in the management of chylous fistulae, and it is suggested by some authors as first-line treatment in the management of these, thus decreasing the complications that can appear due to chyle loss

Leiomiosarcoma vesical. Presentación de un nuevo caso y revisión de la literatura / Bladder leiomiosarcoma. A new case and a review of the literatura

Los leiomiosarcomas de vejiga son tumores mesenquimales excepcionales. Su diagnóstico diferencial con los leiomiomases fundamental para decidir nuestra actitud terapéutica. Presentamos un nuevo caso de leiomiosarcoma vesical con comportamiento agresivo que ha presentado múltiples recidivas, y realizamos una revisión de la literatura para establecerlas pautas terapéuticas más adecuadas (AU)

Bladder Leiomiosarcomas are exceptional mesenchimal tumours. Their differential diagnosis is basic to decide our therapeutic attitude. We present a new case of bladder leiomiosarcoma with a bad behavior and with multiple relapses, and perform a review of the literature in order to establish more properly the therapeutic attitudes (AU)

Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml / Usefulness of PET scans in diagnosing recurrent prostate cancer. Prostate with PSA level < 5 ng/ml

Introducción y objetivo: Evaluamos la utilidad de la tomografía por emisión de positrones (PET) en el diagnóstico de la recurrencia del cáncer de próstata tras tratamiento con intención curativa. Material y métodos: Se sometió a 92 pacientes consecutivos en progresión bioquímica tras cirugía radical (63) o radioterapia (29) a una PET. En todos los casos, se realizaron dos escáneres PET en el mismo día (11C-colina y 18F-FDG). Se evalúa la eficacia de la PET de manera global (utilizando los resultados con 11C-colina y 18F-FDG) y de manera independiente para detectar recurrencia en pacientes con progresión bioquímica. Para ello, se utilizan la comparación de medias para k muestras independientes, tablas de contingencia 2 × 2 y 2× X y curvas ROC. Resultados: 1. PET global: hay evidencia de la alteración de la PET en función del antígeno prostático específico (PSA) (p = 0,003), estadio clínico (p = 0,01). No existe una alteración de la PET estadísticamente significativa en función de la afectación de la biopsia (unilateral o bilateral), los márgenes quirúrgicos, el estadio patológico y el tiempo a progresión. La curva ROC PET-PSA es significativa (p < 0,0001) y permite calcular distintos puntos de corte; PSA = 4,3 ng/ml el que presenta una mayor especificidad (91%). 2. PET 18FDG: el área bajo la curva ROC es significativa (p < 0,0001), con una especificidad del 91% para un PSA =6,51 ng/ml. 3. PET 11colina: el área bajo la curva ROC es significativa (p < 0,0001), con una especificidad del 91% para un PSA = 5,15 ng/ml. Conclusiones: La PET es una herramienta útil en el diagnóstico de la recurrencia de cáncer de próstata tras tratamiento radical con intención curativa (AU)

Introduction and objectives: We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. Material and methods: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-cholineand 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 × 2 and 2 × X contingency tables and ROC curves. Results: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=0.003): the clinical stage (P=0.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P<0.0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET18FDG: the area under the ROC curve is statistically significant (P<0.0001) with a specificity of91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P<0.0001) with a specificity of 91% for a PSA of 5.15 ng/ml. Conclusions: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment (AU)

Linfoma prostático y revisión de la literatura / Prostatic Lymphoma and review of the literature

El linfoma prostático es una patología excepcional que suele diagnosticarse como consecuencia de su sintomatomatología prostática o como consecuencia de su invasión por un linfoma extraprostático. Presentamos un caso de un paciente afecto por un linfoma prostático y realizamos una revisión de la literatura, para establecer las pautas diagnósticas y terapéuticas (AU)

Prostatic Lymphoma is an exceptional pathology, that usually is diagnosed because its prostatic symthomatology or as consequence of its invasion by an extraprostatic lymphoma. We present a case of a patient affected by a prostatic lymphoma and we perform a review of the literature in order to establish the diagnostic and therapeutic steps (AU)

Desarrollo de cálculo vesical tras procedimiento de colocación de malla TVT: A propósito de un caso / Development of bladder stone following a Tension-free Vaginal Tape procedure: Acase report

La formación de un cálculo vesical como consecuencia de la erosión de la mucosa vesical secundaria a la colocación de una malla TVT es una complicación poco frecuente. El caso que presentamos es el de una mujer de 73 años intervenida en dos ocasiones mediante la colocación de una malla TVT con el objeto de tratar su incontinencia urinaria de origen mixto. La clínica de la paciente se caracterizaba por una intensa disuria, urgencia miccional, dolor perineal, diarrea y síndrome constitucional de un año de evolución. Se llegó al diagnostico mediante una placa de abdomen y una RM. El tratamiento se realizó mediante una intervención de cistolitotomía y la sección de la malla protésica sobre la cual se había desarrollado el cálculo. La integridad de la vejiga y la ausencia de lesiones secundarias se constató mediante una cistoscopia realizada a los 6 meses de la intervención (AU)

The bladder stone formation due to intravesical mesh erosion of tension-free vaginal tape (TVT) is an infrequent complication. We report a case of 73 years old woman, treated in two occasions by means of the positioning of a TVT with the intention of treating its urinary incontinence. The symptoms, of a year of evolution, was characterized by disuria, pelvic pain, diarrea and constitutional syndrome. RM showed bladder stone fixed to bladder wall. The extraction of the bladder stone was made by the section of the polypropilene mesh on which the calculi had been developed. 6 months later, control cystoscopy revealed complete healing of bladder mucosa (AU)

Cirugía mínimamente invasiva en cáncer renal / No disponible

No disponible

De la nefrectomía parcial abierta a la robótica / From open to robotic partial nephrectomy

En este trabajo no realizaremos un estudio comparativo de las distintas técnicas (abierta, laparoscópica y robótica) sino más bien analizaremos el cómo, el cuándo y el porqué de cada una de ellas desde una perspectiva histórica. Este análisis histórico comenzará desde finales del siglo XIX hasta llegar a nuestros días. En él, relataremos los principios; la incertidumbre de si se puede realizar. Los fracasos; las complicaciones y las dudas del saber si se está haciendo lo correcto. Y los éxitos de un tratamiento quirúrgico que hoy en día está fuera de toda duda. Todo ello resumido, ya que supone más de cien años de historia de la medicina. La historia que han escrito hombres y mujeres inconformistas que cambiaron el rumbo del tratamiento de la patología renal neoplásica(AU)

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease(AU)

Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal / Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor

Presentamos nuestra experiencia en el desarrollo de programas de formación en cirugía laparoscópica urológica básica y avanzada. Ambos modelos formativos constan de 21 y 28 horas de duración respectivamente. El de tipo básico comienza con el conocimiento de aspectos generales de la ergonomía y del instrumental, tras lo cual los alumnos adquieren destrezas básicas mediante la práctica en simulador físico. Posteriormente se acometen las técnicas en modelo animal, siempre asistidos por profesorado experto. Las actividades avanzadas comienzan con prácticas directas en simulador físico. Posteriormente se acometen técnicas de urología reconstructiva en modelo animal, dando especial importancia a la nefrectomía parcial, siempre asistidos por profesorado experto. Así mismo presentamos los resultados de nuestra experiencia con un modelo basado en alginato cromático para la creación de pseudotumores exofíticos renales(AU)

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate(AU)