[Assessment of radiopaque kidney stone treatment: Combination of extracorporeal shock wave lithotripsy and Fagolitos Plus®. Preliminary case control description.] / Evaluación del tratamiento de litiasis renal radiopaca mediante la combinación de litotricia extracorpórea por ondas de choque y Fagolitos Plus®. Estudio preliminar de casos y controles.

INTRODUCTION: The nutritional supplement called Fagolitos plus® contains hydroxycitric acid as main component, in addition to zinc, magnesium, vitamin A and vitamin B6. It is necessary to study new molecules as chemolytic treatment in calcium lithiasis or that facilitate its fragmentation with the help of other instrumental treatments. OBJECTIVE: The objective of this study is to evaluate the effectiveness of the combined treatment of Fagolitos plus® and extracorporeal lithotripsy in the fragmentation of the lithiasis. MATERIAL AND METHODS: Retrospective case-control study includes 88 patients with lithiasis. Group 1: Treated with 1 session of extracorporeal lithotripsy and Fagoliths plus®. Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were: Age, sex, body mass index, maximum diameter of the stone, area of the stone, hounsfield units of the stone measured by axial tomography, location of the stone, result after 1 session of extracorporeal wave lithotripsy shock [complete fragmentation, partial fragmentation (presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus®, days of treatment with Fagolitos plus® and energy shock wave applied to lithiasis. Results were analyzed with SPSS 20.0, p≤0.05. RESULTS: The mean age of the patients included in the study is 53.81 ± 12.62 years in group 1 compared to 56.53 ± 12.37 years in group 2, p=0.31. According to the distribution by sex, there were no statistically significant differences (p=0.5), including 24 men and 24 women in group 1 and 23 men and 17 women in group 2. The mean of body mass index of the patients in group 1 was 28.39 ± 2.27 kg/m2 in group 1 versus 28.39 ± 3.03 kg/m2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm in group 1 compared to 13.15 ± 5.49 mm in group 2, p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm2 in group 1 compared to 141.91 ± 80.95 mm2 in group 2, p=0.3. The Hounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to 1143.15 ± 172.24 in group 2, p=0.06. Relation to fragmentation, complete fragmentation was observed in 66.7% of group 1 patients, compared to 41% of group 2 patients (p=0.02), between 20-30 days after the first session of Extracorporeal Lithotripsy evaluated by means of a simple X-ray of the Abdomen. CONCLUSIONS: The administration of Fagolitos plus® concomitant to extracorporeal lithotripsy could increase its effectiveness in lithiasis fragmentation, requiring clinical trials and prospective studies to confirm these findings.

INTRODUCCIÓN: El complemento nutricional denominado Fagolitos plus® contiene como principal componente ácido hidroxicítrico, además de zinc, magnesio, vitamina A y vitamina B6. Es necesario estudiar nuevas moléculas como tratamiento quimiolítico en litiasis cálcica o que faciliten su fragmentación con la ayuda de otros tratamientos instrumentales. OBJETIVO: El objetivo de este estudio es evaluar la efectividad del tratamiento combinado de Fagolitos plus® y Litotricia extracorpórea en la fragmentación de la litiasis.MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles, incluye 88 pacientes con litiasis. Grupo 1: Tratados con 1 sesión de litotricia extracorpórea y Fagolitos plus®. Grupo 2: Tratados con 1 sesión de litotricia extracorpórea. Las variables analizadas fueron: Edad, sexo, índice de masa corporal, diámetro máximo de la litiasis, área de la litiasis, unidades hounsfield de la litiasis medida por Tomografía axial, localización de la litiasis, resultado tras 1 sesión de Litotricia extracorpórea por ondas de choque [fragmentación completa, fragmentación parcial (presencia de un fragmento mayor a 5 mm) y ausencia de fragmentación (mismo tamaño de la litiasis)], efectos adversos acontecidos tras la toma de Fagolitos plus®, días de tratamiento con Fagolitos plus® y energía de ondas de choque aplicada a la litiasis. Se analizaron resultados con SPSS 20.0, p≤0,05. RESULTADOS: La edad media de los pacientes incluidos en el estudio es de 53,81 ± 12,62 años en el grupo 1 frente a 56,53 ± 12,37 años en el grupo 2, p=0,31. Según la distribución por sexos, tampoco existen diferencias estadísticamente significativas (p=0,5), incluyendo 24 hombres y 24 mujeres en el grupo 1 y 23 hombres y 17 mujeres en el grupo 2. El índice de masa corporal medio de los pacientes del grupo 1 fue de 28,39 ± 2,27 kg/m2 en el grupo 1 frente a 28,39 ± 3,03 kg/m2 en el grupo 2, p=0,9. El diámetro máximo de la litiasis fue de 11,5 ± 3,91 mm en el grupo 1 frente a 13,15 ± 5,49 mm en el grupo 2, p=0,1. El área de la litiasis medida por tomografía computarizada fue de 104,74 ± 70,56 mm2 en el grupo 1 frente a 141,91 ± 80,95 mm2 en el grupo 2, p=0,3. Las unidades Hounsfield medidas por tomografía de la litiasis en el grupo 1 fue de 1061,98 ± 213,68 frente a 1143,15 ± 172,24 en el grupo 2, p=0,06. En relación con la fragmentación, se observó fragmentación completa en el 66,7% de los pacientes del grupo 1, frente al 41% de los pacientes del grupo 2 (p=0,02) entre 20-30 días tras la primera sesión de Litotricia Extracorpórea evaluado mediante Radiografía simple de Abdomen. CONCLUSIONES: La administración de Fagolitos plus® concomitante a la Litotricia extracorpórea podría aumentar su efectividad en la fragmentación de la litiasis, siendo necesarios ensayos clínicos y estudios prospectivos que confirmen estos hallazgos.

Use of Lidocaine 2% Gel Does Not Reduce Pain during Flexible Cystoscopy and Is Not Cost-Effective.

PURPOSE: To compare the use of lubricant gel with lidocaine versus lubricant gel without anesthetic in flexible cystoscopy in terms of pain and tolerability. MATERIALS AND METHODS: In this observational non-randomized study, 72 patients were divided into two groups. Group 1 included 38 patients in whom lidocaine gel 2% was used and group 2 included 34 patients in whom lubricant gel without anesthetic was administered. The main variables analyzed were score in visual analogue scale (VAS) and score in Spanish Pain Questionnaire (SPQ). Student's t-test and Chi-square test were used to compare differences between 2 groups. The P values < .05% were considered statistically significant. RESULTS: Mean age of patients in group 1 was 64.50 ± 12.39 years and 67.79 ± 10.87 years in group 2 (P = .23). The distribution according to sex was 29 men and 9 women in group 1 and 25 men and 9 women in group 2 (P = .78). The total VAS score was 2.21 ± 2.05 in group 1 versus 1.59 ± 1.61 in group 2 (P = .16). In the SPQ, the current intensity value was 1.82 ± 0.86 in group 1 versus 1.53 ± 0.74 in group 2 (P = .14), and the total intensity value was 1.92 ± 1.86 in group 1 versus 1.03 ± 1.75 in group 2 (P = .04). The cost of gel with lidocaine is 1.25 euro and gel without anesthetic 0.22 euro. CONCLUSION: The use of lidocaine gel does not produce benefit in terms of pain relief in flexible cystoscopy and also is costly.

[Optimization and improvement of surgical indicators in the urology department of a regional hospital of the ministry of health of the Junta de Andalucía]. / OPTIMIZACIÓN Y MEJORA DE LOS INDICADORES QUIRÚRGICOS DEL SERVICIO DE UROLOGÍA DE UN HOSPITAL COMARCAL DE LA CONSEJERÍA DE SALUD DE LA JUNTA DE ANDALUCÍA.

OBJECTIVES: To improve the rates of surgical activity and average waiting times for surgery, and to optimize the number of surgical indications in the Urology Department of a Regional Hospital. METHODS: A study and analysis of the surgical activity and different indexes in 2014 was performed comparing the first half of the year and the second half after implementation of improvement measures. STUDY VARIABLES: operating room occupancy rate, average hospital stay, cancellations, surgical complexity, average number of surgeries per operative room, average global waiting time and waiting time by 120 and 180 days guarantee decrees following the Junta de Andalucía standards. RESULTS: In comparison with the first half of 2014, in the second half the operating room occupancy rate increased from 79% to 85%, the average stay decreased from 6 to 3 days, and a decrease in cancellations from 9% to 6% was observed. Moreover, a decrease in the mean waiting times was observed for surgeries subject to both the 120 days and 180 days guarantee decree and a decrease in the number of surgical indications in urology through the implementation of protocols based on clinical practice guidelines. CONCLUSIONS: Despite the limitations of the study, and being a small Department in a district hospital, we observed that optimization of resources, implementation of protocols, and clinical pathways can improve and optimize different indicators of surgical activity.

Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves.

The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective-with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher's exact test, and Student's t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p < 0.001). Success rate of endoscopic laser lithotripsy for lumbar ureteral stones was 82% versus 57% of ESWL (p = 0.611). In Group B, FAEQ was 8.12. In Group C, success rate was 93.84% with FAEQ of 10.64%. When we compare results from endoscopic lithotripsy with Holmium:YAG laser in Group B with results from ESWL with FAEQ >10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.