[Interobserver agreement in the diagnosis of bladder outlet obstruction in women]. / Variabilidad interobservador en el diagnóstico de obstrucción del tracto de salida vesical en mujeres.

Background: The diagnosis of bladder outlet obstruction (BOO) in women is a challenge for functional urology. In Mexico there are few data that report the prevalence of OTSV in women, being up to 24% in a group of patients. Objective: The aim of this study is to compare six different definitions of bladder outlet obstruction and evaluate the interobserver agreement in an educational setting. Material and Methods: Urodynamic studies (UDS) of women with and without diagnosis of BOO were retrospectively assesed. Farrar, Chassagne, Lemack, Defreitas, Blavais and Groutz, Solomon-Greenwell definitions were evaluated. All UDS were independently reviewed by 5 observers. The easiest, the hardest and the fastest were chosen. Interobserver agreement to classify the patients as obstructed was assessed by kappa reliability statistical analysis. We classified the type of mistakes the participants made; error of interpretation and miscalculation. Results: A total of 28 urodynamic studies were reviewed. All observers had a substantial agreement (0.64-0.78) to classify BOO using all but Lemack and Solomon-Greenwell definitions. A total 120 errors from 840 responses were found; 45.8% errors of interpretation of UDS and 54.1% miscalculation of the equation. Finally, all the participants chose the Solomon-Greenwell was the most difficult definition. Conclusion: Chassagne, Defreitas and Farrar definitions proved substantial interobserver agreement. Solomon-Greenwell and Lemack´s definitions had the highest number of pitfalls and the lowest level of agreement.

Introducción: el diagnóstico de obstrucción de tracto de salida vesical (OTSV) en mujeres supone un reto para la urología funcional. En México existen pocos datos que reporten la prevalencia de OTSV en mujeres, siendo de hasta el 24% en un grupo de pacientes. Objetivo: comparar seis definiciones diferentes de obstrucción de tracto de salida vesical (OTSV) en mujeres y evaluar la concordancia entre observadores en un entorno educativo. Material y métodos: evaluación retrospectiva de estudios urodinámicos de mujeres con y sin diagnóstico de OTSV. Se evaluaron las definiciones de Farrar, Chassagne, Lemack, Defreitas, Blavais y Groutz y Solomon-Greenwell. A todos los participantes se les brindó un taller teórico-práctico para analizar los estudios urodinámicos en su fase de flujo-presión y diagnosticar la OTSV. Los estudios urodinámicos fueron revisados de forma independiente por cinco observadores. La concordancia interobservador para clasificar a los pacientes como obstruidos se evaluó mediante análisis estadístico de confiabilidad kappa. Se clasificó el tipo de errores que cometieron los participantes, error de interpretación de estudios urodinámicos y error de cálculo en los criterios. Resultados: se revisaron en total 28 estudios urodinámicos. Todos los observadores tuvieron una concordancia buena de (0.64-0.78) para clasificar OTSV usando todas las definiciones excepto las de Lemack y Solomon-Greenwell. Se encontraron un total de 120 errores de 840 respuestas, 45.8% errores de interpretación y 54.1% error de cálculo de la ecuación. Los participantes eligieron la definición de Solomon-Greenwell, la más difícil. Conclusión: las definiciones de Chassagne, Defreitas y Farrar demostraron una concordancia sustancial entre observadores. Las definiciones de Solomon-Greenwell y Lemack tuvieron el mayor grado de dificultad y el menor nivel de acuerdo.

Factores de riesgo preoperatorios en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía.

OBJETIVO: Identificar factores de riesgo asociados a complicaciones mayores en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. MÉTODO: Análisis retrospectivo de expedientes clínicos de pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. Se analizaron el sexo, el índice de masa corporal, el índice de comorbilidad de Charlson, la clasificación del estado físico de la American Society of Anesthesiologists, la etapa de Malek, el conteo leucocitario y los valores de creatinina. Las complicaciones se estratificaron en menores y mayores según la clasificación de Clavien-Dindo. Se realizó análisis univariado y bivariado usando las pruebas exacta de Fisher y ji al cuadrado de Pearson, y se establecieron medidas de riesgo utilizando la odds ratio (OR). RESULTADOS: Se analizaron 72 pacientes con una edad media de 50 años, el 83% mujeres, el 58.3% con urocultivo positivo y el 66% con litiasis renal. El 32% tuvieron alguna complicación mayor y el 15% requirieron admisión a la unidad de cuidados intensivos. Los valores elevados de creatinina (OR: 3.8; intervalo de confianza del 95% [IC95%]: 1.1-13; p = 0.02) y la etapa Malek II-III (OR: 4.5; IC95%: 1.2-17.5; p = 0.02) se asociaron con complicaciones mayores. CONCLUSIÓN: El estadio de Malek y los valores elevados de creatinina incrementan el riesgo de desarrollar complicaciones mayores en los pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. OBJECTIVE: To identify preoperative risk factors associated with major complications in patients with xanthogranulomatous pyelonephritis undergoing total nephrectomy. METHOD: Retrospective analysis of patient's charts with xanthogranulomatous pyelonephritis who underwent nephrectomy. Risk factors included for analysis were gender, body mass index, Charlson comorbidity index, American Society of Anesthesiologists physical status classification, Malek's stage, leukocyte count and creatinine levels. Postoperative complications were stratified in minor and major according to Clavien-Dindo's classification. Univariate and bivariate analysis using Fisher's exact test, Pearson's chi-squared and odds ratio (OR) was performed. RESULTS: 72 patients were analyzed, 83% women, mean age of 50 years, 58.3% positive urine cultures and 66% kidney stones. Major complications were present in 32% of cases, and 15% were admitted to the intensive care unit. Elevated creatinine (OR: 3.8; 95% confidence interval [95%CI]: 1.1-13; p = 0.02) and Malek's stage II to III (OR: 4.5; 95%CI: 1.2-17.5; p = 0.02) were associated with major complications. CONCLUSION: The Malek Stage and elevated creatinine increases the risk of major complications in patients undergoing nephrectomy due to xanthogranulomatous pyelonephritis.

Síntomas del tracto urinario inferior como reflejo del ambiente laboral hospitalario en médicos residentes / Lower urinary tract symptoms in medical residents as reflection of a stressful work environment

OBJETIVO: Determinar si la presencia de síntomas del tracto urinario inferior moderados a severos en médicos residentes se asocian con la exposición a bullying laboral. MATERIAL Y MÉTODOS: Estudio transversal realizado en médicos residentes. Se definió síntomas del tracto urinario inferior moderados a severos como más de 8 puntos en el Índice Internacional de Síntomas Prostáticos. Los residentes se consideraron como expuestos a bullying si el puntaje total en la Escala de Conductas Negativas era mayor a 41 puntos. Se consideró como bullying percibido cualquier respuesta positiva en una pregunta específica para medir esta variable. Se realizó un análisis bivariado utilizando la Χ² para determinar diferencias estadísticas entre la presencia de síntomas del tracto urinario inferior y la exposición a ambos tipos de bullying. La magnitud y dirección de las asociaciones se establecieron calculando el Odds Ratio con un intervalo de confianza al 95%. RESULTADOS: Se incluyeron 209 residentes, 63% hombres; 68% refirieron algún síntoma del tracto urinario, de los cuales, 56% fueron leves, 10% moderados y 2% severos. La prevalencia de bullying fue de 42% y el bullying percibido se presentó en el 39%. Los residentes con ≥ 8 puntos en el Índice Internacional de Síntomas Prostáticos tuvieron mayor riesgo de estar expuestos a bullying (OR: 2,8, IC 95%: 1,1-6,7, p = 0,01) y bullying percibido (OR: 3,1 95% CI: 1,3-7,5, p 0,00). Ser mujer se asoció con mayor riesgo de presentar síntomas del tracto urinario inferior (OR: 2,8, IC 95%: 1,1-6,6, p = 0,01). CONCLUSIONES: Los médicos residentes con síntomas del tracto urinario moderados o severos pueden estar relacionados a bullying. Ser mujer se asocia a mayor riesgo de presentar STUI

OBJECTIVE: To determine if the presence of moderate to severe lower urinary tract symptoms in medical resident are associated with workplace bullying. MATERIAL AND METHODS: Cross-sectional study conducted in medical residents. Moderate to severe lower urinary tract symptoms were defined as greater than 8 points on the International Prostate Symptom Score. Residents were classified as bullied if their total score on the Negative Acts Questoinnarie-Revised, was above 41 points. Perceived bullying was considered as present when any positive answer was documented in a specific question to measure this variable. Bivariate analysis to determine statistical differences between presence of lower urinary tract symptoms and exposure to both types of bullying was performed using Χ². The magnitude and directions of all associations were determined by calculating the Odds Ratio with 95% level of confidence. RESULTS: 209 residents were included, 63% men; 68% reported at least one lower urinary tract symptom, of which, 56% were mild, 10% moderate and 2% severe. The prevalence of bullying was 42% while perceived bullying was present in 39%. Residents with ≥ 8 points on the International Prostate Symptom Score had higher risk of being exposed to bullying (OR: 2.8, 95% CI: 1.1-6.7, p = 0.01) and/or perceived bullying (OR: 3.1 95% CI: 1.3-7.5, p = 0.00). Female gender had greater risk than man for presenting lower urinary tract symptoms at basal state (OR: 2.8, 95% CI: 1.1-6.6, p = 0.01). CONCLUSIONS: Medical residents with moderate or severe urinary tract symptoms may be related to bullying. Being a woman is associated with an increased risk of developing LUTS

[Lower urinary tract symptoms in medical residents as reflection of a stressful work environment.] / Síntomas del tracto urinario inferior como reflejo del ambiente laboral hospitalario en médicos residentes.

OBJECTIVE: To determine if the presence of moderate to severe lower urinary tract symptoms in medical resident are associated with workplace bullying. MATERIAL AND METHODS: Cross-sectional study conducted in medical residents. Moderate to severe lower urinary tract symptoms were defined as greater than 8 points on the International Prostate Symptom Score. Residents were classified as bullied if their total score on the Negative Acts Questoinnarie-Revised, was above 41 points. Perceived bullying was considered as present when any positive answer was documented in a specific question to measure this variable. Bivariate analysis to determine statistical differences between presence of lower urinary tract symptoms and exposure to both types of bullying was performed using χ² . The magnitude and directions of all associations were determined by calculating the Odds Ratio with 95% level of confidence. RESULTS: 209 residents were included, 63% men; 68% reported at least one lower urinary tract symptom, of which, 56% were mild, 10% moderate and 2% severe. The prevalence of bullying was 42% while perceived bullying was present in 39%. Residents with ≥8 points on the International Prostate Symptom Score had higher risk of being exposed to bullying (OR: 2.8, 95% CI: 1.1-6.7, p=0.01) and/or perceived bullying (OR: 3.1 95% CI: 1.3-7.5, p=0.00). Female gender had greater risk than man for presenting lower urinary tract symptoms at basal state (OR: 2.8, 95% CI: 1.1-6.6, p=0.01). CONCLUSIONS: Medical residents with moderate or severe urinary tract symptoms may be related to bullying. Being a woman is associated with an increased risk of developing LUTS.

OBJETIVO: Determinar si la presencia de síntomas del tracto urinario inferior moderados a severos en médicos residentes se asocian con la exposición a bullying laboral.MATERIAL Y MÉTODOS: Estudio transversal realizado en médicos residentes. Se definió síntomas del tracto urinario inferior moderados a severos como más de 8 puntos en el Índice Internacional de Síntomas Prostáticos. Los residentes se consideraron como expuestos a bullying si el puntaje total en la Escala de Conductas Negativas era mayor a 41 puntos. Se consideró como bullying percibido cualquier respuesta positiva en una pregunta específica para medir esta variable. Se realizó un análisis bivariado utilizando la χ² para determinar diferencias estadísticas entre la presencia de síntomas del tracto urinario inferior y la exposición a ambos tipos de bullying. La magnitud y dirección de las asociaciones se establecieron calculando el Odds Ratio con un intervalo de confianza al 95%. RESULTADOS: Se incluyeron 209 residentes, 63% hombres; 68% refirieron algún síntoma del tracto urinario, de los cuales, 56% fueron leves, 10% moderados y 2% severos. La prevalencia de bullying fue de 42% y el bullying percibido se presentó en el 39%. Los residentes con ≥8 puntos en el Índice Internacional de Síntomas Prostáticos tuvieron mayor riesgo de estar expuestos a bullying (OR: 2,8, IC 95%: 1,1-6,7, p=0,01) y bullying percibido (OR: 3,1 95% CI: 1,3-7,5, p 0,00). Ser mujer se asoció con mayor riesgo de presentar síntomas del tracto urinario inferior (OR: 2,8, IC 95%: 1,1-6,6, p=0,01). CONCLUSIONES: Los médicos residentes con síntomas del tracto urinario moderados o severos pueden estar relacionados a bullying. Ser mujer se asocia a mayor riesgo de presentar STUI.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser.

INTRODUCTION: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. OBJECTIVE: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. METHOD: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. RESULTS: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. CONCLUSIONS: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

INTRODUCCIÓN: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. OBJETIVO: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. MÉTODO: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. RESULTADOS: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. CONCLUSIONES: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser / Predictors of stone-free status in the first flexible ureteroscopy with laser lithotripsy

Resumen Introducción: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. Objetivo: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. Método: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. Resultados: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. Conclusiones: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Abstract Introduction: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. Objective: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. Method: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. Results: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. Conclusions: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

[Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea].

Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea / Stone-free rate without major complication as a definition of success in percutaneous nephrolithotomy

Resumen Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Abstract Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Rearrangement of the Guy's stone score improves prediction of stone-free rate after percutaneous nephrolithotomy.

OBJECTIVE: We propose a modification of the original Guy's Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone- free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups. RESULTS: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). CONCLUSION: The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

[Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms]. / Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms.

BACKGROUND: The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). METHODS: Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05. RESULTS: 170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms. CONCLUSIONS: Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.

OBJETIVO: comparar la eficacia de tamsulosina, oxibutinina o su combinación para el tratamiento de los síntomas relacionados con el uso de catéter doble J (CJJ). MÉTODOS: ensayo clínico aleatorizado, no cegado, de tres brazos (tamsulosina, oxibutinina o la combinación), para evaluar la mejoría de los síntomas asociados a CJJ con el cuestionario de síntomas asociados a catéteres ureterales (USSQ) y los efectos adversos del tratamiento. Las evaluaciones se hicieron a los 7 y 21 días de colocado el CJJ. Las maniobras se compararon mediante Chi cuadrada, Kruskall-Wallis, ANOVA y Wilcoxon, considerando estadísticamente significativa una p ≤ 0.05. RESULTADOS: se evaluaron 170 pacientes con CJJ. El análisis se realizó por protocolo con 142 pacientes, 53 recibieron tamsulosina (37.4%), 42 oxibutinina (29.6%) y 47 la combinación de ambos (33%). A los 7 y 21 días la mejoría fue similar en los tres brazos. Los hombres con tamsulosina y las mujeres con oxibutinina tuvieron menos síntomas generales. CONCLUSIONES: la tamsulosina, oxibutinina o su combinación mejoran de manera similar los síntomas por CJJ y esta mejoría se hace más notoria a través del tiempo. Los hombres están menos sintomáticos con tamsulosina y las mujeres con oxibutinina.

[Stone free rate assesment after percutaneous nephrolithotomy using nephrolitometric nomogram]. / Evaluación de la tasa libre de litos posterior a la nefrolitotomía percutánea mediante el nomograma nefrolitométrico.

BACKGROUND: Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction. OBJECTIVES: To evaluate the stone-free rate in patients undergoing percutaneous nephrolithotomy with the Clinical Research Office of the Endourological Society nomogram and suggest modifications to improve the classification. MATERIAL AND METHODS: We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3groups: i from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskall-Wallis test was performed, p<0.05). RESULTS: A total of 126 patients were included. According to the nehrolithometric nomogram the stone-free rate was 12.5% for patients with fewer than 111 points and 70.9% for those with 111 points or more. In the modification proposed for groups I, IIand III the stone-free rate was 12.5%, 50% and 80% respectively (p=0.000). CONCLUSIONS: Evaluation using the nephrolithometric nomogram demonstrated accurate stone-free rate prediction for complex and simple stones, with a lack of discrimination for patients with intermediate scores. Our modification enabled better differentiation of the intermediate groups from the high and low stone-free rate groups.

[Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. / Factores pronósticos de morbimortalidad en pacientes con pielonefritis enfisematosa.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 µL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 µL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

[The use of S.T.O.N.E. scale in patients undergoing percutaneous nephrolithotomy]. / USO DE LA ESCALA DE S.T.O.N.E. EN PACIENTES SOMETIDOS A NEFROLITOTOMÍO PERCUTÁNEA.

OBJECTIVES: The aim of this study was to apply the S.T.O.N.E. scale on our patients undergoing PCNL to predict stone free rate and complications using the modified Clavien scale. METHODS: A historical cohort of patients undergoing PCNL was analyzed. All patients with computed tomography to assess stone-free rate with the S.T.O.N.E. scale and complications were evaluated by the modified Clavien scale. RESULTS: In 102 patients 104 procedures were performed; the mean age was 48.4 years and 71% were women. The distribution of cases were classified as mild: 6.7%, moderate: 63.5% and severe: 29.8%. The stone free rate after the first procedure globally reached 58% and by grade was: mild 85.7%, moderate 71.2% and severe 25%. The RR for residual stones after the first procedure was 2.4 for moderate grade (CI 0.3 to 15, p=0.03) and 4.9 for severe grade (CI 0.7 - 30.9, p=0.08). The overall complication rate was 33%, separately Clavien 1: 14.4%, 2: 9.6%, 3a: 2.9%, 3b: 2.9% 4:1.9%, 5:1%. CONCLUSIONS: The S.T.O.N.E. scale applied in our population can predict accurately and easily stone free rate in patients undergoing PCNL. We found no predictive association for this scale on complications.

Uso de la escala de S.T.O.N.E. en pacientes sometidos a nefrolitotomía percutánea / The use of S.T.O.N.E. scale in patients undergoing percutaneous nephrolithotomy

OBJETIVOS: El objetivo del presente trabajo fue aplicar la escala de S.T.O.N.E. a nuestros pacientes sometidos a NLP para predecir el porcentaje de casos libres de litiasis y complicaciones utilizando la escala de Clavien modificada para NLP. MÉTODOS: Se analizó una cohorte histórica de pacientes sometidos a NLP. Se incluyeron pacientes que contaran con tomografía axial computada para evaluar la tasa libre de litiasis con la escala de S.T.O.N.E. y las complicaciones se evaluaron a través de la escala de Clavien modificada. RESULTADOS: En 102 pacientes se realizaron 104 procedimientos de NLP, la edad promedio fue 48.4 años y el 71% fueron mujeres. La distribución de los casos se clasificaron como grado leve: 6.7%, moderado: 63.5% y severo: 29.8%. La tasa libre de litiasis después de un primer procedimiento en forma global alcanzó el 58% y por grados fue: leve 85.7%, moderado 71.2% y severo 25%. El RR para litiasis residual después del primer procedimiento fue de 2.4 para el grado moderado (IC 0.3 - 15, p = 0.03) y 4.9 para el grado severo (IC 0.7 - 30.9, p = 0.08). La tasa global de complicaciones fue del 33%, para Clavien 1 del 14.4%, 2: 9.6%, 3A: 2.9%, 3B: 2.9%, 4:1.9%, 5:1%. CONCLUSIONES: La escala de S.T.O.N.E. aplicada en nuestra población puede predecir de manera correcta y sencilla la tasa libre de litiasis en pacientes sometidos a nefrolitotomía percutánea. No encontramos asociación predictiva en esta escala para las complicaciones

OBJECTIVES: The aim of this study was to apply the S.T.O.N.E. scale on our patients undergoing PCNL to predict stone free rate and complications using the modified Clavien scale. METHODS: A historical cohort of patients undergoing PCNL was analyzed. All patients with computed tomography to assess stone-free rate with the S.T.O.N.E. scale and complications were evaluated by the modified Clavien scale. RESULTS: In 102 patients 104 procedures were performed; the mean age was 48.4 years and 71% were women. The distribution of cases were classified as mild: 6.7%, moderate: 63.5% and severe: 29.8%. The stone free rate after the first procedure globally reached 58% and by grade was: mild 85.7%, moderate 71.2% and severe 25%. The RR for residual stones after the first procedure was 2.4 for moderate grade (CI 0.3 to 15, p = 0.03) and 4.9 for severe grade (CI 0.7 - 30.9, p = 0.08). The overall complication rate was 33%, separately Clavien 1: 14.4%, 2: 9.6%, 3a: 2.9%, 3b: 2.9% 4:1.9%, 5:1%. CONCLUSIONS: The S.T.O.N.E. scale applied in our population can predict accurately and easily stone free rate in patients undergoing PCNL. We found no predictive association for this scale on complications

[Evaluation of 2 inanimate models to improve percutaneous fluoroscopy-guided renal access time]. / Evaluación de 2 modelos inanimados para mejorar el tiempo de acceso renal percutáneo guiado por fluoroscopia.

BACKGROUND: Training devices for percutaneous renal access are expensive, have hazardous biological materials, or radiation. Two devices were designed that eliminate some or all of these characteristics (ManiPERC and iPERC). OBJECTIVE: To compare the improvement in access time to the posterior lower calix with 2 inanimate models in a group of Urology residents. MATERIAL AND METHODS: Quasi-experimental clinical trial with 16 Urology residents to compare the improvement over time of percutaneous renal access by training in 2 inanimate models (iPERC: simulated fluoroscopy and ManiPERC: real fluoroscopy). RESULTS: Subjects were assigned to one of 2 groups (iPERC and ManiPERC) and a video analysis of all of them was performed before and after 20 training sessions. Both groups improved their access time; with iPERC from 133.88±41.40 to 76±12.62s (p=0.006) and from 176.5±85.81 to 68.75 to 18.40s (p=0.007) with ManiPERC. Comparing iPERC versus ManiPERC there was no difference between them in improving access time (ANCOVA: Model F (1.13)=1.598, p=0.228). CONCLUSIONS: Both models are equivalent in improving skills; however, even though none of them generated bio-waste, the absence of radioactive emissions makes iPERC the more advantageous model.

Prognostic factors of morbidity in patients undergoing percutaneous nephrolithotomy.

OBJECTIVE: To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Clavien's classification. MATERIALS AND METHODS: We performed a retrospective chart review of patients who underwent PCNL between January 2005 and January 2012. Preoperative and postoperative factors, such as age, obesity, surgical risk, Charlson comorbidity index, stone complexity, access calix, type of dilator used, and surgery time, were evaluated as predictors of complications. RESULTS: A total of 354 patients were included in the study. Of these, 56% were women, with the average age of 47±12.5 years. Stone-free rate for noncomplex calculi was 85% and for complex calculi it was 68%. A total of 103 complications were recorded (29.3%). According to the modified Clavien classification system, 32 (9%) were grade 1, 39 (11%) were grade 2, 16 (4.5%) were grade 3A, 8 (2.3%) were grade 3B, 3 (0.8%) were grade 4A, 1 (0.3%) was grade 4B, and 4 (1.1%) were grade 5. In multivariate analysis female gender (odds ratio [OR] 3.1, confidence interval [CI] 1.1-8.0), Charlson score of ≥3 (OR 23.2, CI 3.5-151.1), complex stone (OR 4, CI 1.6-9.6), and duration of surgery of ≥120 minutes (OR 2.9, CI 1.2-6.9) were associated with major complications. CONCLUSIONS: PCNL is a safe procedure with acceptable efficacy for the resolution of renal calculi. The safety of the procedure should improve, especially to reduce the presence of severe complications (Clavien ≥3). We identified factors that are associated with severe complications: female gender, high Charlson, complex calculi, and surgical length ≥120 minutes.

Percutaneous nephrolithotomy in crossed fused renal ectopia: superior calyceal access under fluoroscopic control.

OBJECTIVE: To present a case report of crossed fused renal ectopia treated with percutaneous nephrolithotomy at our hospital and to perform a literature review. METHODS/RESULTS: We present the case of a male with renal calculi in a crossed ectopic and fused kidney, treated satisfactorily with percutaneous nephrolithotomy in a one-stage surgery through an upper pole access CONCLUSIONS: Percutaneous nephrolithotomy is a minimally invasive procedure with good results and low morbidity in this kind of patients. It is technically demanding and requires surgeon's ability and experience.

Nefrolitotricia percutánea (NLP) en ectopia renal cruzada con fusión (ERCD): Acceso calicial superior bajo control fluoroscopio / Percutaneous nephrolithotomy in crossed fused renal ectopia: superior calyceal access under fluoroscopic control

OBJETIVO: Presentar un caso de ectopia renal cruzada con fusión tratado con nefrolitotricia percutánea en nuestro hospital y hacer una revisión breve de la literatura. MÉTODOS/RESULTADOS: Presentamos el caso de un hombre con litiasis en un riñón con ectopia renal cruzada fusionada, tratado de manera satisfactoria mediante nefrolitotricia percutánea en un solo tiempo quirúrgico a través de un acceso calicial superior. CONCLUSIONES: La nefroliotricia percutánea es un procedimiento quirúrgico mínimamente invasivo con muy buenos resultados y baja morbilidad en este grupo de pacientes. Es técnicamente demandante y requiere de habilidad y experiencia por parte del cirujano(AU)

OBJECTIVE: To present a case report of crossed fused renal ectopia treated with percutaneous nephrolithotomy at our hospital and to perform a literature review. METHODS/RESULTS: We present the case of a male with renal calculi in a crossed ectopic and fused kidney, treated satisfactorily with percutaneous nephrolithotomy in a one-stage surgery through an upper pole access. CONCLUSIONS: Percutaneous nephrolithotomy is a minimally invasive procedure with good results and low morbidity in this kind of patients. It is technically demanding and requires surgeon's ability and experience(AU)

Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction.

OBJECTIVES: To evaluate the efficacy, complications and outcomes of sphincterotomy with bladder neck incision in patients with voiding dysfunction (VD). METHODS: We evaluated our prospectively established urologic urodynamic database and identified the records of 30 male patients with VD that underwent sphincterotomy between Octuber 1993 and December 2008. The IPSS and urodynamics were analyzed before and after surgery, we recorded the outcomes and complications. Numerical data were analyzed with Student`s t and Wilcoxon tests (p < 0.05). ANOVA was used for the follow up. RESULTS: Thirty patients underwent sphincterotomy with a mean age of 41 years (range 18-63 years). Statistical differences (p< 0.05) were found for: maximum flow rate (17.61 ± 7.7 vs 23.5 ± 12.19 ml/s), detrusor pressure (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), maximum cystometric capacity (462.74 ± 224.2 vs 382.2 ± 167.48 ml), functional urethral length (64.3 ± 22.6 vs 42.2 ± 18.4 mm), Maximum urethral pressure (120.1 ± 46.8 vs 59.23± 22.67 cmH20), total urethral closure area (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) and postvoid residual volume (161.3 ± 177.9 vs 57 ± 100.8 ml). The IPSS improved and was stable at 60 months (p < 0.02). No significant association was found to develop incontinence after the procedure. CONCLUSION: Sphincterotomy for male patients with dysfunctional voiding improves voiding dynamics with a low rate of complications and minimum risk of incontinency.

Resultados y complicaciones de la esfinterotomía con cervicotomía en pacientes masculinos con disfunción miccional neurológicamente sanos / Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction

OBJETIVO: Evaluar la eficacia de la esfinterotomía con cervicotomía en pacientes masculinos con diagnóstico de disfunción miccional (DM) neurológicamente sanos y describir las complicaciones. MÉTODOS: Se realizó un estudio retrospectivo, observacional y longitudinal para evaluar los pacientes masculinos con el diagnóstico de DM, sometidos a esfinterotomía de Octubre de 1993 a Diciembre de 2008. Se evaluó el IPSS y el estudio urodinámico pre y postquirúrgico y la presencia de complicaciones. Las variables cuantitativas con se analizaron mediante T student y Wilcoxon. Se realizó un análisis de la varianza de Friedman y Q Cochrane con p < 0.05 como significativo. RESULTADOS: Treinta pacientes fueron sometidos a esfinterotomía, con un promedio de edad de 41 años (rango 18-63 años). Se encontraron diferencias estadísticamente significativas (p< 0.05) para tasa de flujo máximo (17.61 ± 7.7 vs 23.5 ± 12.19 ml/seg), presión del detrusor al flujo máximo (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), capacidad cistométrica máxima (462.74 ± 224.2 vs 382.2 ± 167.48 cmH20), longitud uretral funcional (64.3 ± 22.6 vs 42.2 ± 18.4 mm), presión uretral máxima (120.1 ± 46.8 vs 59.23 ± 22.67 cmH20), área de cierre total uretral (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) y orina residual (161.3 ± 177.9 vs 57 ± 100.8 ml). Para el IPSS se encontró una diferencia significativa con que se mantuvo a los 60 meses (p <0.02). No se encontró una asociación significativa para incontinencia posterior a la esfinterotomía. CONCLUSIÓN: La esfinterotomía con cervicotomía en pacientes masculinos con DM mejora la dinámica miccional con una baja tasa de complicaciones y con mínimo riesgo de incontinencia(AU)

OBJECTIVES: To evaluate the efficacy, complications and outcomes of sphincterotomy with bladder neck incision in patients with voiding dysfunction (VD). METHODS: We evaluated our prospectively established urologic urodynamic database and identified the records of 30 male patients with VD that underwent sphincterotomy between Octuber 1993 and December 2008. The IPSS and urodynamics were analyzed before and after surgery, we recorded the outcomes and complications. Numerical data were analyzed with Student`s t and Wilcoxon tests (p < 0.05). ANOVA was used for the follow up. RESULTS: Thirty patients underwent sphincterotomy with a mean age of 41 years (range 18-63 years). Statistical differences (p< 0.05) were found for: maximum flow rate (17.61 ± 7.7 vs 23.5 ± 12.19 ml/s), detrusor pressure (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), maximum cystometric capacity (462.74 ± 224.2 vs 382.2 ± 167.48 ml), functional urethral length (64.3 ± 22.6 vs 42.2 ± 18.4 mm), Maximum urethral pressure (120.1 ± 46.8 vs 59.23 ± 22.67 cmH20), total ure-thral closure area (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) and post void residual volume (161.3 ± 177.9 vs 57 ± 100.8 ml). The IPSS improved and was stable at 60 months (p < 0.02). No significant as-sociation was found to develop incontinence after the procedure. CONCLUSION: Sphincterotomy for male patients with dysfunctional voiding improves voiding dynamics with a low rate of complications and minimum risk of incontinency(AU)