El aprendizaje de la nefrolitectomía percutánea en posición supina. Estudio observacional multicéntrico / Learning of percutaneous nephrolithotomy in supine position. An observational multicenter study

Objetivo: Estudiar prospectivamente los resultados operatorios y las complicaciones de la nefrolitectomía percutánea (NLP) en posición supina para valorar la dificultad de su aprendizaje y cómo afecta la experiencia a los resultados. Establecer una comparación relativa con los datos publicados en la literatura acerca de la posición en prono. Material y métodos: Estudio prospectivo observacional multicéntrico sobre NLP en posición de Valdivia o en su variante de Galdácano. Se recogen variables demográficas y variables específicas dependientes de la litiasis. Se valoran aspectos técnicos, tiempo quirúrgico, tasa de éxito y complicaciones según la clasificación de Clavien-Dindo. Resultados: Desde septiembre de 2008 a junio de 2011 se han registrado 335 NLP en posición supina realizadas en 13 centros españoles. La proporción hombre/mujer fue 1:1,28 y la edad media 51,3 + 14,5 años; 211 (63%) casos fueron realizados por urólogos con experiencia de > 50 casos y 124 (37%) por urólogos con menos experiencia. El tiempo operatorio medio fue 113,3±46,4min, 106,6±38,2 en experimentados vs. 124,9±56,2 en noveles (p<0,002). No se detectó diferencia en el tamaño medio de la litiasis, pero en el grupo con experiencia se trató una mayor proporción de casos coraliformes y de litiasis múltiples que en el grupo novel (p<0,001). La tasa de éxito evaluada como ausencia total de restos litiásicos fue 69,6%, sin diferencias entre grupos (68,2 vs. 71,8%). En 102 (30,6%) pacientes hubo litiasis residual, precisando tratamiento complementario 60 (17,9%). La tasa relativa de éxito global fue 82,1% y la tasa de complicaciones 25,4%, sin detectarse diferencias entre grupos. No obstante, el grupo novel presentó mayor número de complicaciones mayores (p>0,001). Conclusión: La NLP en supino está teniendo una rápida y consolidada difusión en nuestro entorno, y su efectividad y seguridad parece equivalente a la descrita en la literatura para la NLP en prono. Resulta posible conseguir buenos resultados con una modesta curva de aprendizaje. La tasa de complicaciones mayores asociadas al procedimiento disminuye con la experiencia (AU)

Objective: To prospectively study the post-operative results and complications of percutaneous nephrolithotomy (PNL) in supine position to assess difficulty of learning it and how experience affects the results. To establish a relative comparison with the data published in the literature on the prone position. Material and methods: A prospective observational multicenter study on PNL in Valdivia position or in its Galdakao variant was performed. Demographic variables and specific variables related to the lithiasis were collected. Technical aspects, surgery time, success rate and complications according to the Clavien-Dindo classifications were assessed. Results: A total of 335 PNL in supine position conducted in 13 Spanish centers were registered from September 2008 to June 2011. The man: woman ratio was 1:1.28 and mean age 51.3 + 14.5 years. 211 (63%) cases were performed by urologists with experience in > 50 cases and 124 (37%) by urologists with less experience. Mean operation time was 113.3±46.4min, 106.6±38.2 for the experienced ones vs. 124.9±56.2 in the novice ones (P<0.002). No difference was detected in the mean size of the lithiasis. However, in the experienced group, there was a greater proportion of coraliform cases and multiple lithiasis than in the novice group (P<0.001). Success rate evaluated as total absence of lithiasic residuals was 69.6%, without differences between groups (68.2 vs. 71.8%). In 102 (30.6%) patient had residual lithiasis and 60 (17,9%) required complementary treatment. Relative global success rate was 82.1% and complications rate 25.4%, without detecting differences between groups. However, the novel group had more major complications (P>0.001). Conclusion: The PNL in supine position is obtaining rapid and consolidated diffusion in our setting and its effectiveness and safety seems to be equivalent to that described in the literature for PNL in prone position. It is possible to obtain good results with a modest learning curve. The rate of greater complications associated to the procedure decreases with experience (AU)

[Learning of percutaneous nephrolithotomy in supine position. An observational multicenter study]. / El aprendizaje de la nefrolitectomía percutánea en posición supina. Estudio observacional multicéntrico.

OBJECTIVE: To prospectively study the post-operative results and complications of percutaneous nephrolithotomy (PNL) in supine position to assess difficulty of learning it and how experience affects the results. To establish a relative comparison with the data published in the literature on the prone position. MATERIAL AND METHODS: A prospective observational multicenter study on PNL in Valdivia position or in its Galdakao variant was performed. Demographic variables and specific variables related to the lithiasis were collected. Technical aspects, surgery time, success rate and complications according to the Clavien-Dindo classifications were assessed. RESULTS: A total of 335 PNL in supine position conducted in 13 Spanish centers were registered from September 2008 to June 2011. The man:woman ratio was 1:1.28 and mean age 51.3+14.5 years. 211 (63%) cases were performed by urologists with experience in >50 cases and 124 (37%) by urologists with less experience. Mean operation time was 113.3 ± 46.4 min, 106.6 ± 38.2 for the experienced ones vs. 124.9 ± 56.2 in the novice ones (P<.002). No difference was detected in the mean size of the lithiasis. However, in the experienced group, there was a greater proportion of coraliform cases and multiple lithiasis than in the novice group (P<.001). Success rate evaluated as total absence of lithiasic residuals was 69.6%, without differences between groups (68.2 vs. 71.8%). In 102 (30.6%) patient had residual lithiasis and 60 (17,9%) required complementary treatment. Relative global success rate was 82.1% and complications rate 25.4%, without detecting differences between groups. However, the novel group had more major complications (P>.001). CONCLUSION: The PNL in supine position is obtaining rapid and consolidated diffusion in our setting and its effectiveness and safety seems to be equivalent to that described in the literature for PNL in prone position. It is possible to obtain good results with a modest learning curve. The rate of greater complications associated to the procedure decreases with experience.

[Urethral duplication: report of 2 clinical variants]. / Duplicidad uretral: aportación de dos variedades clínicas.

The present paper is a contribution of two cases of urethral duplication. The first one developed in a paediatric patient and corresponded to a bifid urethra with a pre-anal branch. Diagnosis was based on the patient's signs and symptoms (perianal dripping during miction) and both retrograde and mictional urethrocystography. The therapeutical approach consisted in complete removal of the accessory or supernumerary urethra. The second case developed in an adult patient and the duplication corresponded to a "rifle" urethra. The patient's clinical picture (urinary retention) justified a radiological study of the urethra leading to diagnosis. The therapeutical approach followed was endoscopic resection of both ducts and the surrounding prostatic tissue. Features related to the embryology, signs and symptoms, and therapeutic approach of these malformations are referred.