Curva de aprendizaje de la ecografía renal en una unidad docente pluriprofesional / Renal ultrasound learning curve performed in a multiprofessional teaching unit

Introducción: El objetivo de esta experiencia fue analizar un módulo formativo inserto en la práctica asistencial de un departamento de urología con la participación de enfermeras especializadas en ecografía urológica como monitoras. Material y métodos: Participaron en el estudio 12 estudiantes de medicina carentes de cualquier conocimiento de ultrasonografía. Su formación corrió a cargo de dos enfermeras con gran experiencia en ecografía. Después de dos sesiones de entrenamiento, se analizó la concordancia entre sus hallazgos en la exploración de los riñones y los de un urólogo especialista. Para analizar la experiencia desde todos los puntos de vista, se exploró el grado de aceptación del módulo formativo por parte de los usuarios y la tolerancia de los profesionales involucrados en términos de síndrome de desgaste profesional (SDP). Por último, se calcularon los costes. Resultados: El coeficiente kappa de concordancia entre el experto y los estudiantes fue bueno (≥ 0,67) en el 58,3% de los casos. No se detectaron rasgos de SDP entre los involucrados en la experiencia. La participación de las enfermeras como monitoras redujo el coste del operativo en un 25% en comparación con los costes en los que se podría haber incurrido caso de docentes urólogos senior. Conclusiones: Las enfermeras pueden proporcionar los rudimentos de la formación en ecografía a legos en la materia. La exploración de individuos con cálculos renales o ureterohidronefrosis se traduce en una mayor concordancia entre observadores. El usuario involucrado acepta de buen grado la experiencia. El operativo resulta inocuo para el personal participante.

Introduction: The objective of this experience was to analyze a training module inserted in the care practice of an urology department, with the participation of nurses specialized in urological ultrasound as monitors. Material and methods: Twelve medical students with no knowledge of ultrasonography participated in the study. His training was carried out by two nurses with extensive experience in ultrasound. After two training sessions, the agreement between their kidney examination findings and those of a specialist urologist was analyzed. To analyze the experience from all points of view, the degree of acceptance of the training module by the users was explored, as well as the tolerance of the professionals involved in terms of professional burnout syndrome (PBS). Finally, the costs of the operation were calculated. Results: The kappa coefficient of agreement between the expert and the students was good (≥ 0.67) in 58.3% of the cases. No traits of PBS were detected among involved in the experience. The participation of nurses as monitors reduced the cost of the operation by 25% compared to the costs that could have been incurred if they had been senior urologist teachers. Conclusions: Nurses can provide the rudiments of sonography training to laymen. Examination of individuals with kidney stones or ureterohydronephrosis results in greater interobserver agreement. In general, the user involved willingly accepts the experience. The operation is harmless for the participating staff.

Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors - A single center study.

PURPOSE: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. PATIENTS AND METHODS: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient's record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. RESULTS: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expß 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expß 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expß 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. CONCLUSIONS: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.

[Salvage surgery of hydraulic penile prosthesis by modified Mulcahy protocol. Case report and literature review]. / Cirugía de rescate de extrusión de prótesis hidráulica de pene mediante protocolo de Mulcahy modificado. Revisión de la literatura a propósito de un caso.

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis. We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions. The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations. Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function.

[Primary testicular lymphoma. Two new case reports]. / Linfoma testicular primario. A propósito de 2casos nuevos.

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease.

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications.

OBJECTIVE: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). INCLUSION CRITERIA: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. EXCLUSION CRITERIA: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. RESULTS: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadad-scale) and has a low risk of bias (Cochrane-Handbook). CONCLUSIONS: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

[Glandectomy with cutaneous thigh graft]. / Glandectomía con injerto cutáneo de muslo.

Penile cancer is a neoplasm that predominantly affects males in the sixth decade of life, with an incidence of .3-1 per 100,000. Traditionally, the treatment of the primary lesion has consisted of total or partial amputation of the penis. However, the psychological and functional impact has influenced the development of preservation techniques We present 2males with lesions on the glans diagnosed by biopsy of squamous cell carcinoma. The patients underwent glandectomy and reconstruction with free thigh skin graft. The pathological anatomy was superficial squamous cell carcinoma. 6 months later the patients are free of disease and satisfied with the result of the intervention In our opinion, this technique enables an adequate cosmetic and functional result without affecting oncological control and without increasing morbidity or operative time.

[Laparoscopic management of horseshoe kidney stones.] / Tratamiento laparoscópico de la litiasis en el riñón en herradura.

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical characteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment. MATERIAL AND METHODS: We present the cases of men with horseshoe kidneys diagnosed by CT one case of alarge pyelic lithiasis with others of a smaller size in the calyces, and the other of a big solitary lithiasis in renal pelvis. RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cystoscope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasisis a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope allows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.

OBJETIVO: El riñón en herradura constituyela anomalía de la fusión más frecuente. Sus características anatómicas incrementan la formación de litiasis y dificultan su resolución. MATERIAL Y MÉTODOS: Presentamos dos varones con riñones en herradura diagnosticados mediante TC abdominal en un caso de litiasis piélica de 5 cm y en el otro de una litiasis en pelvis renal con otras caliciales más pequeñas. Realizamos una pielolitectomía laparoscópica extrayendo las litiasis piélicas utilizamos introducimos un cistoscopio flexible por un trocar para extraer las litiasis caliciales. RESULTADOS: El postoperatorio cursó sin incidencias y retiramos el catéter doble jota 3 semanas después sin evidenciar fuga urinaria ni litiasis residual, encontrándose los pacientes 6 meses después sin litiasis. CONCLUSIONES: El abordaje laparoscópico de la litiasis constituye una alternativa en los casos complejos como en el riñón en herradura. Utilizar un cistoscopio flexible permite navegar en las cavidades renales aumentando la eficacia del abordaje.

[Long term results of congenital penile curvature treated with cavernosa corpora rotation.] / Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos.

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck's fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test.  RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length,(p=0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results.

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos(RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica,(p=0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo.

[Comparison of monopolar versus bipolar transurethral resection of the prostate: Evaluation of the impact on sexual function]. / Comparación entre resección monopolar vs. resección bipolar transuretrales de próstata y su impacto sobre la función sexual.

OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status.

Post void incontinence secondary to female urethral diverticulum. / Incontinencia postmiccional secundaria a diverticulo uretral femenino.

A 38 year old woman with nopast medical or surgical history of interest,derived by occasional dysuria and post voidincontinence by her family doctor, with negativeurine culture...

Mujer de 38 años sin antecedentesmédico-quirúrgicos de interés, remitida porsu médico de familia por disuria ocasional eincontinencia postmiccional, con sistemáticode orina negativo...

Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

BACKGROUND: Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men. METHODS: The Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population data. We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios. Spatial autoregressive models of Besag-York-Mollié provided smoother municipal estimators of PC mortality risk (all ages; <65 years). We computed the provincial age-standardized rate ratios of PC hospital admissions (all men; <60 years) using Spanish rates as the reference. RESULTS: A total of 29,566 PC deaths (6% among those <65 years) were registered between 2010-2014, with three high-mortality risk zones: Northwest Spain; Southwest Andalusia & Granada; and a broad band extending from the Pyrenees Mountains to the north of Valencia. In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The PC hospital discharge rates confirmed a North-South gradient but also low mortality/high admission rates in Madrid and Barcelona and the opposite in Southwest Andalusia. CONCLUSION: The consistent high PC mortality/morbidity risk in the Northwest of Spain indicates an area with a real excess of risk. The different spatial pattern in younger men suggests that some factors associated with geographical risk might have differential effects by age. Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain.

Priapismo de alto flujo postraumático en paciente pediátrico tratado con embolización arterial selectiva / Postraumatic high-flow priapism in pediatric patient treated with selective arterial embolization

El priapismo arterial es una rara patología en pacientes pediátricos, originada por una fístula entre la arteria cavernosa y los sinusoides del cuerpo cavernoso, habitualmente secundaria a un traumatismo perineal. Presentamos el caso de un varón de 16 años con priapismo arterial de 5 días de evolución tras una caída a horcajadas, tratado satisfactoriamente mediante embolización arterial supraselectiva con material reabsorbible. Seis meses después, el paciente presenta detumescencia completa sin disfunción eréctil asociada. La embolización arterial en pacientes pediátricos es compleja debido al menor calibre arterial y la necesidad de control de la arteria pudenda interna contralateral para evitar el desarrollo de complicaciones. La utilización de material reabsorbible permite disminuir el riesgo de disfunción eréctil posterior y, aunque presenta un mayor índice de recurrencias, constituye una alternativa eficaz en el tratamiento de esta patología.

Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.

[Postraumatic high-flow priapism in pediatric patient treated with selective arterial embolization]. / Priapismo de alto flujo postraumático en paciente pediátrico tratado con embolización arterial selectiva.

Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.

A different method of evaluation of the ERSPC trial confirms that prostate-specific antigen testing has a significant impact on prostate cancer mortality.

The advantages and disadvantages of two different methods of analyzing the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial with respect to the effect of prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality (ie, disease-specific mortality analysis and excess mortality analysis) are discussed in depth. The traditional disease-specific mortality is the best end point, but it could be biased by misclassification of causes of death, and it does not take into account the possible effect of the screening process on other causes of death. Excess mortality analysis overcomes these problems, but the results could be biased if the expected mortality is not corrected for attendance status. Both methods, when applied to the ERSPC trials, demonstrate that no increase in non-PCa mortality occurred in the screening group and confirm that PSA screening decreases PCa mortality.