Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. / Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19.

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option¼ after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.

[Primary hypospadias]. / Hipospadias primario.

Hypospadias is one of the most frequent male congenital anomalies. Its surgical correction is under permanent review and it is always controversial. The best surgical technique can only be chosen intraoperatively, since it is the level of corpus spongiosum division what marks the severity of the case, although it is essential to evaluate position of the meatus, penile curvature, quality of the preputial skin and penile size. It is recommended treatment age between 6-12 months. Nowadays, The most frequently used technique for hypospadias repair is the Snodgrass tubularized incised urethral plate (TIP). Moreover, distal and medial hypospadias may be treated with urethral advance or flap techniques and proximal hypospadias with modifications of these in one-step or two-step procedures. Nevertheless, there are other controversies about hypospadias, such as to preserve or not the prepuce, the use of central or peripheral anesthesia blockade, or the use of wound dressings.

Assessment of the psychometric properties of the Spanish language version of questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

OBJECTIVES: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). MATERIAL AND METHODS: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24. RESULTS: Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not. CONCLUSION: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.

[Clinical pathways for the care of multiple sclerosis patients]. / Diseño de una vía clínica para la atención a los pacientes con esclerosis múltiple.

INTRODUCTION: clinical pathways are standard health care methods to coordinate clinical work, reduce inter-clinician variability, improve patient care and increase staff and patient satisfaction. The aim of this study is to develop a clinical pathway capable of organising and developing standard procedures for diagnosis, treatment and care in patients with multiple sclerosis and to coordinate all medical specialists involved in this disease. METHODS: a multidisciplinary unit for the care of MS patients was developed. All of them and quality specialists analysed some international evidence-based studies, clinical guides, international guidelines and other clinical neurological pathways in several meetings and designed several documents for the clinical pathways. RESULTS: a clinical pathway was created consisting of a scientific-technical framework, which arranges the care in relation to the diagnosis and reatment. The framework is accompanied by various patient-information documents on the disease, an information sheet on diagnostic procedures and a map of the process. Quality standards were established to achieve continuous improvement in patient care. CONCLUSIONS: a clinical pathway for the care of MS patients in a multidisciplinary unit homogenises and organises the care which the MSpatient should receive from the initial symptoms to the progressive stages. This clinical pathway improves the quality of patient care, reduces the variability in work protocols and rationalises the use of the available health care resources.

[Clinical trial to evaluate trospium chloride (Uraplex) effectiveness and tolerance in patients with detrusor instability incontinence and its impact on quality of life]. / Ensayo clínico para evaluar la eficacia y tolerancia del cloruro de trospio (Uraplex) en pacientes con incontinencia por inestabilidad del detrusor y su repercusión en la calidad de vida.

OBJECTIVE: To determine the efficacy, tolerance and quality-of-life effects of trospium chloride in women with overactive bladder. METHODS: An open, prospective multicenter trial was conducted on 75 women with urinary incontinence from overactive bladder (ICS criteria, urodynamic evaluation). Trospium chloride was administered at a dose of 20 mg twice daily for 8 weeks. Neurological examination and cystometry were performed at the start of the trial. Quality of life was evaluated by analogue visual scales (faces scale) and EUROQOL (health status scale). At the 4th week, urodynamic, clinical, quality-of-life and tolerance evaluations were performed. Clinical and tolerance data and quality of life index were assessed at the 8th week. RESULTS: 8 of the 75 patients did not complete the study. Thus, analysis of the therapeutic efficacy was performed in 67 patients, while description and tolerance analyses were performed for the overall group of patients. Urodynamic parameters significantly improved at 4 weeks: maximum bladder capacity (232.09 ml pre-treatment vs 315.83 ml post-treatment) and first desire to void (100.9 ml pre-treatment vs 156.7 ml post-treatment). Incontinence clinical items also improved. All quality-of-life indixes significantly increased at the 4 and 8 weeks control evaluation. Excellent or very good tolerance was observed in 89.5% of the patients. CONCLUSIONS: The results of the study corroborate the efficacy and tolerance of trospium chloride in the management of overactive bladder in women. Improvement in patient quality of life was also observed.

Excision and anastomotic repair for urethral stricture disease: experience with 150 cases.

PURPOSE: To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure. MATERIAL AND METHODS: 150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence). RESULTS: One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%. CONCLUSION: Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.

Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors.

PURPOSE: We analyzed a series of 59 reno-ureteral units with upper tract urothelial carcinoma treated endourologically at our institution. MATERIALS AND METHODS: Between January 1980 and January 1995, 54 of 185 patients with a clinically diagnosed upper tract tumor were considered candidates for endourological treatment. Of the patients 14 had either bilateral disease or a solitary kidney. The primary approach was ureteroscopy in 39 reno-ureteral units and percutaneous nephroscopy in 20. Superficial stage pTa, T1 or Tis disease was noted in 48 cases, infiltrating stage pT2 cancer in 4 and inverted papilloma in 4, while the tumor was impossible to classify in 3. A total of 32 patients received adjuvant supplemental therapy. RESULTS: Ureteroscopy failed in 11 cases (28.2%), with salvage by nephroureterectomy in 6 and percutaneous nephroscopy in 5. Primary nephroscopy failed in 3 cases (15%) that were salvaged by open surgery. Two patients died of unrelated causes postoperatively and 14 (26%) had intraoperative or late complications that were treated conservatively in 12. After a mean followup of 30.6 months (range 2 to 119), 2 patients died of progressive upper tract tumor, 2 died of concurrent bladder cancer and 2 died of a second cancer. Of 42 upper tracts treated solely by endourological means 10 (23.8%) had recurrences, which were treated endourologically in 6. Bacillus Calmette-Guerin and mitomycin C seemed to be effective at preventing recurrences, with recurrence rates of 12.5 and 14.2%, respectively, compared to 60% for thiotepa, and 40% for oral combination 5-fluorouracil and uracil. CONCLUSIONS: Endourological treatment of low grade, small, noninvasive tumors of the upper urinary tract is a feasible and safe alternative even in patients with a normal contralateral kidney.

[Urethroplasty with lyophilized human dura mater]. / Uretroplastia con duramadre humana liofilizada.

OBJECTIVE: This article reports our experience with lyophilized human dura in the treatment of complex urethral stenosis. METHOD: Seven patients with iatrogenic/inflammatory urethral stricture underwent a 13 cms long x 1.5 cms wide medial urethral augmentation. RESULTS: During a mean follow-up of 23 months, good results accounted for 85.7%. CONCLUSION: Lyophilized dura patches constitute a suitable choice in selected patients who, for local or systemic reasons, are not good candidates for other urethroplasty procedures.

[Renal cyst communicating with excretory tract: report of a case]. / Comunicación de quiste renal con la vía excretora: aportación de un caso.

Simple renal cyst communicating with the excretory tract is a rare complication frequently arising from obstructive uropathy. In most of the cases treatment continues to be conservative.

[Nephrogenic adenoma of the upper and lower urinary tract. Apropos of 22 cases]. / Adenoma nefrogénico del tracto urinario superior e inferior. A propósito de 22 casos.

Nephrogenic adenoma (NA) is a lesion that can present in the urothelium--from the renal pelvis to the urethra-, and is considered to be immature metaplasia arising from chronic aggression. We report 22 cases of NA in 21 patients that had been diagnosed and treated in our service from 1975 to 1990. The lesion was found at all levels of the urinary tract: renal pelvis (1 case), ureter (1 case), bladder (16 cases) and urethra (4 cases). The present series was comprised of 15 males (one with bladder NA and recurrence in urethra) and 6 females, with ages ranging from 24 to 79 years (mean 55). The diagnosis was made on the histological findings in all cases and the etiology of the lesion was multiple: previous surgery (11 cases), previous or coexisting urothelial carcinoma (8 cases), intracavitary chemotherapy and/or pelvic radiotherapy (3 cases), previous history of tuberculosis (5 cases), interstitial cystopathy (4 cases), lithiasis (2 cases), permanent catheter (3 cases) and urethral stenosis (1 case). Treatment and prognosis was influenced by the underlying urological disease. NA per se does not carry an unfavourable prognosis.

[A Foley-type catheter with a steerable tip]. / Sonda de tipo Foley con extremo dirigido.

Permanent bladder catheterization for medical or social reasons increases the risk of complications, especially urinary infection. We evaluated the usefulness of the balloon catheter with a steerable intravesical tip in reducing the volume of residual urine between the bladder neck and the balloon of the conventional Foley catheter. The results show that this new catheter affords no additional advantage over the conventional catheter.

[The imaging diagnosis of adrenal tumors]. / Diagnóstico por imagen de los tumores suprarrenales.

From 1967 to 1991 we have diagnosed and treated 73 adrenal tumors in 63 patients: 12 pheochromocytomas, 24 adrenal cortical adenomas, 15 hyperplasias, 16 carcinomas, 3 myelolipomas, 2 cysts and 1 neuroblastoma. We conducted a retrospective study to analyze the preoperative images obtained by different diagnostic techniques and attempted to correlate tumor size and site with the results of the histological analysis of the surgical specimen. Nephrotomography with pneumoretroperitoneum and IV Nephrotomography were useful in detecting the increase of the size of the gland in 10 of 25 cases submitted to these procedures (40%). Arteriography as second or third technique of choice confirmed the presence of an adrenal tumor in 15 of the 21 cases evaluated by this procedure (70%). US and CT detected 94% (31/33) and 100% (33/33) of the cases, respectively. Fourteen cases were incidentally discovered by CT (7) and US (7). A direct relationship between tumor size and degree of malignancy could be established since the carcinomas had a mean diameter of 7 cm (range 5 to 12 cm). Concerning the histologic nature of the disease, specific images were found in 3 cases of adrenal myelolipoma (hyperechoic on US and of low density similar to fat on CT) and 2 cysts (anechoic with posterior band evidenced on us and liquid on CT). Radioisotopes were also utilized for tumor localization and there was positive uptake of I-131-IMBG in 2 cases of adrenal pheochromocytoma; 1 extra-adrenal (left lateral aortic paraganglioma) and 1 case of malignant adrenal pheochromocytoma with metastasis to the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Giant lithiasis in left ureterocele. Its endoscopic resolution]. / Litiasis gigante en ureterocele izquierdo. Resolución endoscópica.

Herein we describe a case of giant calculus in an orthotopic ureterocele in a female patient who had consulted for recurrent left-sided nephritic colic. A plain film of the urinary tract prompted us to suspect a giant calculus, which was confirmed by IVP. Treatment was by endoscopic surgery. The patient has remained asymptomatic one year postoperatively.

[Controversies over regional lymphadenectomy in carcinoma of the penis]. / Controversias sobre la linfadenectomía regional en el carcinoma de pene.

Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type. The presence or absence of inguinal metastasis is an essential prognostic factor. Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed. Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution. Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks. Of these, 3 had a positive node biopsy. They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1). The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases). The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer. This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3).

[Our experience with the diagnosis and treatment of 429 renal traumatisms]. / Nuestra experiencia en el diagnóstico y tratamiento de 429 traumatismos renales.

We studied 429 cases (3 bilateral) of renal injuries in 426 patients diagnosed and treated at our service from 1965 to 1990. Four-hundred twenty (98.59%) were blunt and 6 (1.41%) were penetrating injuries. In 313 the renal lesions were grade I (72.96%), 69 grade II (16.08%), 27 grade III (6.29%) and 20 were traumatic injuries to pathologic kidney (4.66%). Surgery was performed immediately in 67 cases (15.61%) (35 grade II, 21 grade III, and 11 previously pathological kidneys). Surgery was delayed in 34 cases (7.92%) (1 grade I, 23 grade II, 5 grade III and 5 pathological kidneys). Three-hundred twenty-eight cases (76.45%) were managed conservatively (312 grade I, 11 grade II, 1 grade III and 4 cases of traumatic injury to previously pathological kidney). Preservation of the renal unit was achieved in 100% of those with grade I lesions and in 91.17% of those with grade II that had been treated conservatively or submitted to delayed surgery. Of the grade II lesions that were immediately treated, 22.58% required a nephrectomy procedure. Of the grade III lesions and the cases of traumatic injury to previously pathological kidney, nephrectomy was required in 72% and 65%, respectively, although delayed surgery permitted more precise indication in a hemodynamically stable patient. The mortality rate in our series was 1.87 (8/426).

[Should kidney grafts from donors less than 3 years old be used?]. / Se deben utilizar los injertos renales de donantes menores de tres años?

In order to determine the results of renal transplantation using pediatric donors younger than three years of age, a retrospective analysis of a series of 43 transplant recipients was carried out. Methods of immunosuppressive regimen were similar for all patients. They are divided into two groups. Whose donors where younger than three years of age and older than three years. Actuarial graft and patient survival, causes of graft failure, surgical and postoperative complications were compared without significant differences between groups. The results support the contention that pediatric patients younger than three years should be considered to be potential cadaveric kidney donors.

[Kidney injuries in childhood: our experience in 64 cases]. / Traumatismos renales en la infancia: nuestra experiencia en 64 casos.

From 1969 to 1988, 64 children under 5 years of age with renal trauma were treated at our Urology service. Trauma was classified as grade I in 34, grade II in 23, grade III in 3, and 4 patients presented with trauma to pathologic kidney. Eight patients were submitted to immediate surgery (3 grade II, 3 grade III, and 2 with trauma to pathologic kidney). Twelve were initially treated conservatively and were deferred for surgery (11 with grade II trauma and 1 with trauma to pathologic kidney). The remaining 44 patients (34 grade 1, 9 grade II, and 1 with trauma to pathologic kidney) only received medical treatment. The renal unit could be salvaged in 34 cases with grade I trauma (100%) and in 2 of 3 (66.6%) with grade III trauma who underwent immediate surgery. In patients with grade II trauma submitted to immediate surgery, 1 out of 3 patients (33.3%) required a nephrectomy procedure, whereas in those patients submitted to conservative treatment and or deferred surgery, only 1 out of 20 (5%) required a nephrectomy procedure. The results reported in the literature are discussed and compared with our results.

[Renal candidiasis: percutaneous endoscopic treatment of the pyeloureteral fungus-ball]. / Candidiasis renal: tratamiento endoscópico percutáneo del fungus-ball pieloureteral.

We report three cases of pyelic fungus ball from Candida albicans in two patients (one bilateral) with lithiasic urinary obstruction that were treated endo-urologically by percutaneous nephroscopy and with adjuvant antifungal medication. The infection mechanism, nephroscopy procedure and results obtained are discussed.

[Endo-urologic treatment of the uretero-intestinal stenoses in patients subjected to diversion]. / Tratamiento endourológico de las estenosis ureterointestinales en pacientes derivados.

Surgical repair of uretero-enteric strictures in patients with enteric conduit urinary diversion (incidence rate 4-8%) is difficult and has a high morbidity. With the development of endo-urologic techniques and ureteral catheters, long-term insertion of stents in the treatment of strictures has become possible and safe. We have performed long-term uretero-enteric stenting with 7-8 Fr double-J catheters in 5 patients with 6 strictures: 3 ureteroileal and 3 uretero-colic. In three cases (2 colonic conduits, 1 ileal conduit) the stent was inserted anterogradely following intercostal renal percutaneous punctures and dilatation of the stricture with teflon dilators (1 case), balloon catheter (1 case), or following the incision of the stricture (1 case). In one patient with a double uretero-enteric stricture of the ileal conduit, guide-wires were successfully inserted retrogradely which permitted subsequent high pressure dilatation of the uretero-ileal strictures with a 15 Fr balloon catheter. We used the same approach in another patient with a right uretero-colic stricture. The catheters were left indwelling for 7 to 35 months and were changed every 3 months with no remarkable observations other than 3 episodes of fever which quickly resolved with antibiotic treatment. Although is has been reported that uretero-enteric strictures are particularly refractory to endo-urologic treatment and a significant morbidity rate has been associated with long-term ureteral stenting, our results show that the approach was well-tolerated by all of the patients.