The relationship between calcium oxalate lithiasis and chronic proinflammatory intestinal dysbiosis pattern: a prospective study.

The objective is to establish whether a pattern of intestinal dysbiosis exists in calcium oxalate (CaOx) lithiasis and, if so, to identify its characteristics and explore whether there are differences in the pattern between CaOx dihydrate (COD) and monohydrate (COM) lithiasis. With this aim 24 patients diagnosed with CaOx lithiasis by means of optical microscopy and spectrometry were prospectively recruited. Faecal analysis was carried out by means of RT-PCR 16S rRNA assay and agar plate culture according to the methodology proposed by the Institute of Microecology (Herborn, Germany). The total number of bacteria was depleted due to COD lithiasis (p = 0.036). The mean values of immunoregulating microbiota were normal, but the percentage of normal values was lower in the COD group (30%) than in the COM group (69.2%) (p = 0.062). The total mean values of protective microbiota were normal in both groups. There was a large decrease in the mean values of the muconutritive microbiota Akkermansia muciniphila and Faecalibacterium prausnitzii, the most intense decline being observed in the COD group (p = 0.019). Levels of proteolytic microbiota were elevated in both groups, without differences between them. We conclude that patients with CaOx lithiasis have a chronic pro-inflammatory intestinal dysbiosis pattern characterised by a reduction in the total number of bacteria, a reduction in immunoregulating microbiota and a large reduction in muconutritive microbiota that is significantly more intense in COD lithiasis than in COM lithiasis.

Simultaneous and synchronous bilateral endoscopic treatment of urolithiasis: a multicentric study.

INTRODUCTION: The general prevalence of bilateral urolithiasis has risen to 15% and bilateral non-simultaneous treatment has been reported to have good outcomes. The objective of this study was to evaluate the effectiveness and safety of simultaneous bilateral endoscopic surgery (SBES). MATERIAL AND METHODS: An international multicenter analysis was performed between May 2015 and December 2017. All patients with bilateral stone disease that underwent SBES were included. Patients were treated under general anesthesia in either the supine or lithotomy position. Demographic, clinical, intraoperative and postoperative data were analyzed. RESULTS: A total of 47 patients were included. Mean age was 53.8 years and 70% of the patients were males. The mean American Society of Anesthesiology (ASA) score was 2. The mean diameter of right- and left-sided stones was 29.43 mm (2-83 mm) and 31.15 (4-102 mm), respectively. Staghorn stones were treated in 18 cases (8 right-sided and 10 left-sided), four of them were defined as complete staghorn. The procedures performed were 42 cases of bilateral URS and PCNL and ureteroscopy. Additionally, 5 bilateral flexible ureteroscopy (fURS) cases were described. Intraoperative complications occurred in five patients: four of them were classified as Clavien-Dindo (CD) I and one as CD II. Postoperatively, there were two cases with CD I, 6 with CD II and one CD IIIa.The stone-free status was 70%. Residual stones (30%) were detected only on the side treated for high-volume (complete) staghorn calculi. CONCLUSIONS: SBES is a feasible, effective and safe procedure. It may potentially avoid repeated anesthetic sessions as needed for staged procedures and reduce the length of patients' hospital stay.

Simple Laparoscopic Nephrectomy in Stone Disease: Not Always Simple.

OBJECTIVES: Simple nephrectomy is performed for a benign pathology that does not require the excision of either the adrenal gland or any adenopathies. When it is carried out in cases of stone disease, however, it is frequently not a "simple" technique owing to the presence of significant inflammation and infection. METHODS: Ninety-six simple laparoscopic nephrectomies performed because of stone disease between 2006 and 2015 were retrospectively studied. A descriptive statistical analysis was performed, as well as an evaluation of the associated complications. RESULTS: Of the 96 laparoscopic nephrectomies (62 left, 34 right), 7 (7.2%) had to be converted into open surgery owing to the impossibility of dissecting the renal hilum because of xanthogranulomatous pyelonephritis (n = 4) or major associated lesions (n = 3). The indication for nephrectomy was lumbar pain associated with urinary infection, with a partial renal function below 15% assessed by DMSA renal scan. There were three major complications. Pathologic assessment revealed chronic pyelonephritis with kidney atrophy and associated pyonephrosis in 85 cases, xanthogranulomatous pyelonephritis in 10, and pT4 squamous cell carcinoma in 1. CONCLUSIONS: Despite its high technical difficulty, simple laparoscopic nephrectomy for stones is a viable technique for advanced laparoscopists. Its principal advantage compared with open surgery is improved postsurgical recovery, and it is associated with an acceptable complication rate. Xanthogranulomatous pyelonephritis is not an initial contraindication to laparoscopy, but it is the most significant risk factor for conversion to open surgery.

International Collaboration in Endourology: Multicenter Evaluation of Prestenting for Ureterorenoscopy.

INTRODUCTION: Semirigid and flexible ureterorenoscopy (URS) procedures are safe and efficient treatment options for urolithiasis of all localizations. Sometimes, a Double-J stent is placed in preparation of definitive treatment. The aim of our study was to evaluate the influence of prestenting on the outcome of URS. PATIENTS AND METHODS: We retrospectively analyzed 565 patients of our prospective, multicenter multinational database who underwent URS for renal or ureteral stones from June 2011 to December 2013. Demographic and stone-related data, surgery time, stone clearance, and complications were evaluated. Statistical analysis was performed comparing the prestented and nonstented groups. RESULTS: Demographic data, stone size, and localization were comparable in both groups. Three hundred twenty-three patients were prestented and 242 nonstented. Overall, prestenting had significant influence on the stone-free rate (SFR) (86% prestented vs 74% not prestented, p = 0.0003) and complication rate (6.5% vs 14.5%, p = 0.003), but not on surgery time (55 ± 36 minutes vs 61 ± 35 minutes, p = 0.071). Subgrouped, this was also true for renal stones (83% vs 60%, p = 0.0001, odds ratio [OR] 3.15; confidence interval, CI [1.77, 5.62]/8.7% vs 19.4%, p = 0.02, 0.39 [CI 0.19, 0.83]). For ureteral stones, there was no significant influence on SFR (94% vs 90%, p = 0.4, OR 1.63 [CI 0.63, 4.22]), but significantly more complications (3.1% vs 10.7%, p = 0.02, OR 0.27 [CI 0.08, 0.86]) in the nonstented group. CONCLUSION: Prestenting positively affects safety and efficacy of URS. This is more pronounced in the treatment of kidney stones compared with ureteral stones. Although the SFR for ureteral stones is comparable without prestenting, the complication rate is higher.

The Spanish linguistic validation of the ureteral stent symptom questionnaire.

BACKGROUND AND PURPOSE: Ureteral Stent Symptoms Questionnaire (USSQ) is an intervention-specific health-related quality-of-life (HrQoL) measure. We describe development and validation of the Spanish version. MATERIALS AND METHODS: We followed established methods to develop the Spanish version of the original USSQ. After pilot testing, we conducted a formal validation study; 70 patients, undergoing placement of ureteral stents, successfully completed the Spanish USSQ as well as the EuroQoL-5D (male and female), the ICIQ male and female lower urinary tract symptoms questionnaires at weeks 1 and 4 after stent insertions, and at week 4 after their removal. In addition, 40 healthy people acted as a control group and completed the same questionnaires twice at 3-week intervals. Statistical analyses were performed to evaluate reliability, validity, and sensitivity to change of the Spanish USSQ. RESULTS: After revision of the initial two drafts after translation, back translation, and pilot testing, a final draft was developed that underwent field testing. Psychometric analyses revealed satisfactory internal consistencies (Cronbach alpha coefficients: 0.73-0. 85) and test-retest reliability (Spearman correlation coefficient: >0.6) for the domains of urinary symptom, body pain, and general health. It demonstrated satisfactory discriminant validity (sensitivity to change, p<0.01), convergent validity (good correlations between the domains of the USSQ and existing validated questionnaires), and test-retest reliability (p<0.001). Analysis of the domains of the sexual matter (21.4%) and work performance (35.7%) were limited because of the small proportion of the study population for whom it was applicable. CONCLUSIONS: Results of our development and validation study demonstrate that the new Spanish version of the USSQ is a psychometrically valid intervention-specific measurer for use in the second most common language in the world. It is a reliable outcome measure that could be used for both clinical and research purposes.

[The Open Access Initiative (OAI) in the scientific literature]. / La Iniciativa Open Access (OAI) en la literatura científica.

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urológicas Españolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English.

[Spanish bottled and tap water analysis and their relation with urinary lithiasis]. / Análisis de las aguas embotelladas y de grifo españolas y de las implicaciones de su consumo en la litiasis urinaria.

OBJECTIVE: To perform a chemical analysis of all the available waters in Spain with the idea of offering consume recommendations to lithiasic patients. MATERIAL AND METHODS: Information research of the chemical composition of Spanish tap and bottled water in publications, supermarkets and Internet. A descriptive study, and a correlation study between water components by means of Pearson test were performed. RESULTS: Information about composition from tap water of most of the main Spanish cities and 85 bottled water brands was found. A significant correlation between calcium and magnesium concentration (p = 0.0001) and high correlation between bicarbonate and sodium concentration (p = 0.0001, Pearson coefficient 0.958) was found. It is also offered water classifications according to calcium, bicarbonate, sodium and magnesium concentrations. CONCLUSION: A guideline about water election for lithiasic patients is offered according to their geographical origin and dietetic preferences, mainly lactic consume.

Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract.

Acute bacterial prostatitis (ABP) (NIH Category I), has not undergone any modification in the update of prostatitis classification. ABP was diagnosed in 614 patients in our centre over 9 years (1993-2001). We analyse the clinical pattern of ABP and the role of bladder outlet obstruction in its etiology, as well as whether two different ABP sub-categories could be defined as a function of a history of previous manipulation of the lower urinary tract. The results of the study show that the clinical pattern of a patient suffering from ABP does not differ from the statements of previous publications. On the other hand, patients with ABP have been shown to present with no bladder outlet obstruction. Finally, this study has disclosed the fact that the cases of ABP elicited by previous manipulation of the lower urinary tract (10%) show a different pattern from those cases where no previous manipulation has occurred (90%). The patients with ABP secondary to manipulation are older, have a higher risk of prostate abscess and higher frequency of multiple infections and also infections by pathogens other than Escherichia coli. Due to all of these reasons, it would be advisable to subdivide category I within the classification of prostatitis.

[Treatment of urinary calculi in transplanted kidney with extracorporeal shock wave lithotripsy]. / Tratamiento de la litiasis urinaria en el riñón trasplantado mediante litotricia extracorpórea por ondas de choque.

OBJECTIVES: To know the factors associated to a successful result in the treatment of kidney transplant lithiasis by extracorporeal shockwave lithotripsy (ESWL). METHODS: From 850 kidney transplants performed at our center, we analyze 15 patients who developed urinary stones. Successful result by ESWL was the dependent variable, and size, location, and multiplicity of the stones were independent variables. Associations between variables were studied by the chi-square test (categorical variables) and the U-Mann Whitney test (continuous variables). RESULTS: Incidence was 1.76%. ESWL effectiveness was 87%; it was greater in solitary stones than in multiple stones (p = 0.001). No significant differences were found for stone size, although largest stones had a high risk for insertion of a nephrostomy tube (p = 0.013). Finally, ESWL was more effective for stones located at the ureteral anastomosis, although this difference was found not significant. CONCLUSIONS: The treatment of kidney transplant lithiasis by ESWL has an effectiveness of 87%. The best result was found for solitary stones located at the ureteral anastomosis.

[Efficacy of finasteride in the treatment of hematuria associated with benign prostatic hypertrophy]. / Eficacia de finasterida en el tratamiento de la hematuria asociada a la hiperplasia prostática benigna.

OBJECTIVE: To evaluate the efficacy of finasteride in the treatment of prostatic origin haematuria. METHODS: This is a prospective observational study in 29 patients with hematuria from a demonstrated prostatic-origin which were treated with finasteride 5 mg/day. 58.6% had undergone previous prostatic surgery. Both previous-to-treatment hematuria and response to treatment were evaluated under the Puchner & Miller's criteria. RESULTS: Response rate was 86.2% without additional haematuria episodes. The remaining patients had mild haematuria episodes during follow-up. No patient needed surgery. CONCLUSIONS: Finasteride is effective in the treatment of prostatic-origin haematuria.

[Radical cystectomy for superficial tumors in the BCG era]. / Cistectomía radical en tumores superficiales en la era de la BCG.

OBJECTIVE: To analyze the indications and outcome of cystectomy for superficial bladder cancer since the introduction of BCG therapy. METHODS: From June 1990 to December 1996, 384 patients underwent cystectomy for transitional cell bladder tumor. A retrospective study was carried out on 43 cases (11.1%) that underwent cystectomy for Tis, Ta, T1 tumors. The characteristics of patients with superficial bladder cancer, correlation between the clinical stage (determined after TUR) and pathological findings (cystectomy specimen) and outcome were analyzed. RESULTS: 36 patients were male and 7 were female; mean age 63 years (range 39-79). Mean follow-up was 48 months (8-120). Twenty-nine patients received BCG therapy prior to surgery. No response to BCG was the main indication for cystectomy. By clinical stage, 79% were high grade, 65% T1 and 65% CIS. A correlation between the clinical stage and the pathological findings was found in 32.5%, overstaging in 28% and understaging in 39.5%. The increase in stage after analysis of the surgical specimen in 13 patients (30%) was due to progression of the superficial bladder tumor to infiltrating or metastatic tumor. Urinary tract tumor was found during follow-up in 8 patients (18.6%). Eleven patients died of bladder cancer, 3 of other causes and 29 (67%) are free of disease. Seven of the 13 patients (53%) that were clinically understaged and had infiltrating tumor or metastasis died. CONCLUSIONS: No response to BCG therapy was the main indication for cystectomy. Before starting conservative treatment for high risk superficial bladder cancer, the possibility of endoscopic understaging should be taken into account. Patients undergoing cystectomy for superficial bladder cancer have a high risk of developing urinary tract tumor.