Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM) / Cultural adaptation to Spanish (Spain) of the questionnaire

Objetivo: El OAB-FIM se desarrolló como una medida del impacto de la vejiga hiperactiva en los familiares que conviven con el paciente. El objetivo fue realizar la adaptación cultural al español (España) del cuestionario OAB-FIM. Métodos: La adaptación incluyó una fase de validación conceptual y lingüística, y otra de medición de las propiedades psicométricas en 25 familiares (edad media 63,0 años [DE: 14,3], siendo el 44% mujeres) con convivencia habitual con pacientes con vejiga hiperactiva, de ambos géneros y ≥18 años. Se midieron equivalencia conceptual y lingüística, fiabilidad interna, validez de constructo y validez de contenido. Se valoró la aplicabilidad y carga de administración. Resultados: El OAB-FIM fue equivalente conceptual y lingüísticamente al original, manteniendo sus 6 dominios: social, viajes, preocupación, irritabilidad, sueño y sexual. El acuerdo interjueces ubicó correctamente a todos los ítems en su dominio, excepto el 10, que se ubicó más en preocupación que en irritabilidad, motivando su reformulación. Un 2,95% de ítems estuvieron ausentes. Los efectos suelo y techo de los ítems variaron, respectivamente, entre 20-28% y 0-16%. El tiempo medio para cumplimentar el cuestionario fue de 5,2 minutos (DE: 2,8) y un 24% necesitó algún tipo de ayuda. El coeficiente α-Cronbach varió entre 0,948-0,839. Las correlaciones con escalas similares en el familiar fueron moderadas-altas (0,407-0,753) o pequeñas-moderadas con las administradas al paciente (0,004-0,423). Conclusión: Se ha obtenido una versión española (España) del OAB-FIM conceptual y lingüísticamente equivalente al original. El cuestionario ha mostrado buena consistencia interna y validez de contenido y constructo, además de ser aplicable

Objective: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. Methods: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. Results: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). Conclusion: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability

Cultural adaptation to Spanish (Spain) of the "Overactive Bladder - Family Impact Measure (OAB-FIM)" questionnaire. / Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM).

OBJECTIVE: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. METHODS: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. RESULTS: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). CONCLUSION: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability.

Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

OBJECTIVES: To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. MATERIAL AND METHODS: A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. RESULTS: Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value<0.05. Following the "core-by-core" analysis, the detection rates by core of CEUS-targeted biopsy versus randomized biopsy were: Global population (16% vs. 13%), stage cT1 (30.3% vs. 28%), and stage cT2 (48% vs. 37%), with a p value>0.05. The NNT for CEUS-targeted biopsy was 83.3. CONCLUSIONS: The low sensitivity, specificity, positive predictive and negative predictive values of gray scale-B-mode, PDUS and CEUS represent scant diagnostic performance of these variables in prostate cancer detection. Prostate cancer detection rates yielded by randomized biopsy were superior than the detection rate of targeted biopsy using B-mode, PDUS and CEUS; as a result, randomized biopsy versus CEUS-targeted biopsies cannot be excluded from biopsy strategy plans for the diagnosis of prostate cancer.

[Urethral diverticulum. Our casuistic and the literatura review]. / Divertículos uretrales. Revisión de nuestra casuística y de la literatura.

PURPOSE: The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. MATERIALS AND METHODS: A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. RESULTS: In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. CONCLUSIONS: Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries.

Divertículos uretrales. Revisión de nuestra casuística y de la literatura / Urethral diverticulum. Our casuistic and the literatura review

Objetivo: Se valoran los posibles factores etiopatogénicos y se describen la clínica, métodos diagnósticos, abordaje quirúrgico, resultados y complicaciones del manejo de los divertículos uretrales. Material y métodos: Se realizó una revisión retrospectiva de las historias clínicas con diagnóstico de divertículo uretral en el periodo 1986-2006. Resultados: Durante estos 20 años se han tratado un total de 19 pacientes con esta patología: 15 mujeres y 4 hombres. Cinco de las mujeres debutaron clínicamente con sensación de masa vaginal; el resto fueron diagnosticadas en el contexto de un síndrome miccional, incontinencia urinaria o infección urinaria. En el caso de los varones, 3 de ellos presentaron una tumoración palpable en el pene. La prueba diagnóstica más utilizada fue la uretrocistografía miccional seriada; la uretrografía con sonda de doble balón se utilizó en 5 ocasiones y la uretroscopia en 4 pacientes. En los casos más complejos se utilizaron otras técnicas de diagnóstico por la imagen, como la resonancia magnética nuclear. El tratamiento fue la extirpación del divertículo en todos los pacientes, excepto en una mujer que rechazó la intervención. La evolución de las pacientes ha sido satisfactoria realizándose controles periódicos hasta dos años después de la intervención. Dos de los casos, en varones, tuvieron recidivas complejas. Conclusiones: Los divertículos uretrales son una entidad nosológica de difícil diagnóstico dada su baja prevalencia y su clínica inespecífica lo que motiva que, en algunas ocasiones, el diagnóstico sea incidental. La etiopatogenia es adquirida en la mayoría de los casos y su tratamiento quirúrgico, con peores resultados en los hombres debido, probablemente, a que los divertículos se producen en uretras con antecedentes de cirugías previas, manipulación endourológica o lesiones asociadas

Purpose: The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. Materials and methods: A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. Results: In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. Conclusions: Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries

[Double J catheter loop as consequence of endourologic procedure: case report]. / Bucle intrapiélico con catéter doble J en procedimiento endourológico: a propósito de un caso.

We present a report of a patient that had a iatrogenic double J catheter loop after endourology procedure (neumatic balloon dilatation of ureteral estenosis) as well as its therapeutic management.

Bucle intrapiélico con catéter doble J en procedimiento endourológico: a propósito de un caso / Double J catheter loop as consequence of endourologic procedure: case report

Presentamos el caso clínico de un paciente sometido a un procedimiento endourológico (dilatación neumática con balón de estenosis ureteral) que presenta en el transcurso del mismo un bucle iatrogénico del catéter doble J y su posterior manejo terapéutico

We present a report of a patient that had a iatrogenic double J catheter loop after endourology procedure (neumatic balloon dilatation of ureteral estenosis) as well as its therapeutic management

[Endoscopic treatment of pielo-uretheral lithiasis with Holmium-YAG laser. Two years of experience]. / Tratamiento endoscópico de la litiasis pieloureteral mediante láser Holmium-YAG. Dos años de experiencia.

OBJECTIVE: To show the efficiency and safety of Holmium laser in the treatment of pyeloureteral lithiasis, based on our own experience since the introduction of this source of energy in our department. MATERIAL AND METHODS: From January 2002 to February 2004, we have carried out 198 ureterorenoscopies using Holmium laser to treat lithiasis located in the upper urinary tract. In all cases, a previous radiological study demonstrated the stone. Follow-up, where the efficacy of the treatment was assessed, was done with a scout x-ray after 3-4 weeks. We evaluated the localization and features of the lithiasis, technical aspects, results and complications of our series. RESULTS: The most common localization of the lithiasis was the pelvic ureter (59%), with the number of treated cases in both the iliac and lumbar ureter being similar (16%). 70% of the lithiasis had a size between 0.5 and 1.5 cm, and 15% showed a diameter bigger than 1.5 cm. In 61.8% of cases, laser lithotripsy was carried out under spinal anaesthesia, being the average of the pulses used 2532 (confidence interval 95%), using a working power of 1 J in all cases. The overall efficacy of the procedure in terms of size and localization was 95.5%. The complication rate was scarce (2.19%). CONCLUSIONS: Holmium laser lithotripsy is a very effective and safe procedure since in our experience it is 95.5% efficient for pyeloureteral lithiasis treatment and has a low rate of complications.

Tratamiento endoscópico de la litiasis pieloureteral mediante láser Holmium-YAG. Dos años de experiencia / Endoscopic treatment of pielo-uretheral lithiasis with Holmium-YAG laser. Two years of experience

Objetivo: Demostrar la eficacia y seguridad del láser Holmium-YAG en el tratamiento de litiasis pieloureterales, de acuerdo con la experiencia acumulada en nuestro centro desde la introducción de esta fuente de energía. Material y métodos: Entre Enero del 2002 y Febrero del 2004 realizamos 198 ureterorrenoscopias utilizando un láser Holmium para el tratamiento de litiasis localizadas en el tracto urinario superior. En todos los casos el diagnóstico se realizó mediante un estudio radiológico previo. Evaluamos la eficacia del procedimiento mediante una radiografía simple a las 3-4semanas de la intervención, considerándolo eficaz si los restos litiásicos eran menores de 2 mm o inexistentes. Analizamos la localización y las características de las litiasis, sus aspectos técnicos, resultados y complicaciones de nuestra serie. Resultados: La localización más frecuente de las litiasis fue el uréter pélvico (59%), siendo similar el número de casos tratados tanto en uréter iliaco como lumbar (16%). Un 70% de las litiasis tenían un diámetro mayor entre0,5 y 1,5 cm, y el 15% eran mayores de 1,5 cm. En el 61,8% de los casos, la litotricia se realizó con raquianestesia, siendo la media de pulsos utilizados para la litofragmentación en la serie de 2532 (intervalo confianza 95%) utilizando una potencia de trabajo de 1J en todos los casos. La eficacia global del procedimiento en función del tamaño y localización de las litiasis fue del 95,5%. La tasa de complicaciones fue escasa (2,19%).Conclusiones: La litofragmentación con láser Holmium-YAG es un procedimiento eficaz y seguro ya que, en nuestra experiencia, consigue una eficacia del 95,5% en el tratamiento de litiasis pielo-ureterales con escasas complicaciones (AU)

Objective: To show the efficiency and safety of Holmium laser in the treatment of pyeloureteral lithiasis, based on our own experience since the introduction of this source of energy in our department. Material and methods: From January 2002 to February 2004, we have carried out 198 ureterorenoscopies using Holmium laser to treat lithiasis located in the upper urinary tract. In all cases, a previous radiological study demonstrated the stone. Follow-up, where the efficacy of the treatment was assessed, was done with a scout xray after 3-4 weeks. We evaluated the localization and features of the lithiasis, technical aspects, results and complications of our series. Results: The most common localization of the lithiasis was the pelvic ureter (59%), with the number of treated cases in both the iliac and lumbar ureter being similar (16%). 70% of the lithiasis had a size between 0.5 and 1.5 cm, and 15% showed a diameter bigger than 1.5 cm In 61.8% of cases, laser lithotripsy was carried out under spinal anaesthesia, being the average of the pulses used 2532 (confidence interval 95%), using a working power of 1 J in all cases. The overall efficacy of the procedure in terms of size and localization was 95.5%. The complication rate was scarce (2.19%). Conclusions: Holmium laser lithotripsy is a very effective and safe procedure since in our experience it is 95.5% efficient for pyeloureteral lithiasis treatment and has a low rate of complications (AU)

[Melanosis of the bladder: a very uncommon entity]. / Melanosis vesical: una entidad de muy infrecuente presentación.

Melanosis of the bladder is a rare entity characterized by anomalous deposits of melanin-containing pigment on the vesical urothelium without melanocytic atypia or associated malignant melanoma. To our knowledge and following such strict criteria, there are only five cases previously reported. The biological potential of this entity is uncertain because of the rarity of their. We report one case of simple melanosis of the bladder confirmed by histological examination and inmunohistochemistry analysis. We believe that recognition of this entity is important.

Melanosis vesical: una entidad de muy infrecuente presentación / Melanosis of the bladder: a very uncommon entity

La melanosis vesical es una entidad caracterizada por depósito anómalo de pigmento melánico en la mucosa urotelial sin atipia celular asociada, que condiciona una coloración oscura de la mucosa vesical en su visión macroscópica. Es muy infrecuente, ya que, en nuestra revisión de la literatura únicamente encontramos cinco casos publicados. El potencial biológico de esta entidad es desconocido, debido a la extremada rareza en su presentación. Presentamos un caso de melanosis vesical confirmado por estudio histológico y análisis inmunohistoquímico. Pensamos que es necesario tener presente la existencia de esta entidad, así como saber reconocerla para poder establecer el diagnóstico diferencial con el melanoma vesical maligno

Melanosis of the bladder is a rare entity characterized by anomalous deposits of melanin-containing pigment on the vesical urothelium without melanocytic atypia or associated malignant melanoma. To our knowledge and following such strict criteria, there are only five cases previously reported. The biological potential of this entity is uncertain because of the rarity of their. We report one case of simple melanosis of the bladder confirmed by histological examination and inmunohistochemistry analysis. We believe that recognition of this entity is important

Nocardial infection in immunosuppressed kidney transplant recipients.

OBJECTIVE: Nocardiosis is a very rare, opportunistic infection caused by microorganisms of the genus Nocardia, and is associated with significant morbidity and mortality in kidney transplant patients receiving immunosuppressive therapy. MATERIAL AND METHODS: Since 1980, our Renal Transplant Unit has carried out 1239 kidney transplants, and five cases of Nocardia infection have occurred during this time. In this retrospective study, special consideration is given to clinical manifestations, treatment response (efficacy and side-effects) and the evolution of both the patient and the graft. Microbiological factors studied included biochemical profiles and antimicrobial sensitivity. RESULTS: Nocardiosis was observed in five men with a mean age of 49.2 years who had received immunosuppressive therapy (generally cyclosporin/azathioprine and prednisone) for a mean of 47.8 months (range 1-148 months). Four of the patients had good previous renal function. The clinical presentation of nocardiosis was as follows: pleuropulmonary pattern of infection, n = 3; subcutaneous abscess, n = 1; and fulminant multi-organ disseminated nocardiosis, n = 1. In all cases, direct observation using modified Ziehl-Neelsen staining proved positive, and in vitro culture revealed good sensitivity to trimethoprim-sulfamethoxazole and variable sensitivity to the other groups of antibiotics. Nocardia brasiliensis was isolated in two cases, and Nocardia asteroides in three. Two patients died, one due to multiple organ involvement and the other due to acute respiratory failure associated with severe hepatopathy caused by hepatitis C virus. The remaining cases improved. CONCLUSION: A low incidence of nocardiosis following kidney transplantation was observed. Fatal cases occurred in patients with bacteremia and serious comorbid medical conditions, in whom early diagnosis and specific treatment was required.

[Complications of uretero-renoscopy]. / Complicaciones de la uretero-renoscopia.

INTRODUCTION: Since its clinical introduction ureteroscopy (URS) has experienced an impressive development due to the technical improvements of new and smaller urological armamentarium. Currently, ureteroscopy is a worldwide procedure with a varied number of diagnostic and therapeutic possibilities. However, the technique has complications. MATERIAL AND METHODS: We analyse the complications of URS in a series of 4.645 ureteroscopic procedures performed from january 1990 to december 2001, 2972 (64%) female and 1673 (36) male. The objectives of URS were diagnostic (haematuria) and therapeutic (ureteral stones, tumors, strictures and placement of stents). RESULTS: Fever was the most frequent complication (11.7%), with sepsis in 15 patients. Another complications were: ureteral perforation (1.2%), ureteral avulsion (0.06%), renal injury (0.04%), extrusion (0.4%) and uretero-iliac fistulae (0.02%). The most common treatment was conservative with endourological approach. CONCLUSION: Carefully performed ureteroscopy is a superb tool for the urologist either for diagnostic or therapeutic purposes with a low ratio of complications. The majority of these complications can be solved with conservative management.

Complicaciones de la uretero-renoscopia / Uretero-renoscopy complications

INTRODUCCIÓN: Desde que en 1980 se introdujera la ureteroscopia (URS) en la práctica urológica los grandes avances tecnológicos han permitido que esta técnica se convierta en un instrumento bastante seguro y eficaz para el diagnóstico y tratamiento de la patología del tracto urinario superior. Sin embargo es una técnica invasiva y por lo tanto no está exenta de riesgos, pudiendo ocasionar en algunas ocasiones complicaciones graves. MATERIAL Y MÉTODOS: Entre enero de 1990 y diciembre de 2001 hemos realizado 4.645 URS, 2.972 (64 por ciento) en mujeres y 1.673 (36 por ciento) en hombres, con edades comprendidas entre 9 y 82 años (media 49,8). Del total 2.508 (53,9 por ciento) se hicieron con sedación y 2.137 (46,1 por ciento) con anestesia (general o raquídea). Los objetivos de las URS han sido tanto diagnósticos (hematurias de origen desconocido) como terapéuticos (cálculos ureterales, tumores del tracto urinario superior, estenosis ureterales y colocaciones de catéteres ureterales).RESULTADOS: La complicación más frecuente ha sido la fiebre (11,7 por ciento), evolucionando a sepsis en 15 pacientes. El resto de complicaciones fueron: perforación ureteral (1,2 por ciento), avulsión ureteral (0,06 por ciento), rotura renal (0,04 por ciento), extrusión litiásica (0,4 por ciento) y fístula uretero-ilíaca (0,02 por ciento). La mayoría se resolvieron con tratamiento conservador y en muchos casos endoscópico. CONCLUSIONES: La URS ha supuesto un gran avance en la urología, tanto con fines diagnósticos como terapéuticos. Cuidadosamente realizada y bien indicada es una técnica segura, eficaz y con escasa morbilidad, siendo practicada en muchos casos sin necesidad de anestesia. En la mayoría de las ocasiones las complicaciones se pueden resolver de manera conservadora y muchas endoscópicamente (AU)

Infección urinaria en el embarazo y menopausia / Urinary tract infection during pregnancy and menopause

OBJETIVO: Revisar el tema de las infecciones urinarias durante el embarazo y la menopausia. Las infecciones urinarias (IU) de la embarazada y de la mujer tras la menopausia representan un problema de gran relevancia dentro del campo de la patología urológica infecciosa. En el primer caso por las particulares condiciones que exigen su diagnóstico y tratamiento y las consecuencias que comportan tanto para la madre como para el feto. En el segundo caso la importancia radica en el numeroso grupo de población que las mujeres menopáusicas representan dentro de una pirámide de población cada vez más envejecida en los países desarrollados y la demanda de una calidad de vida acorde con las expectativas, cada día más prolongadas, de longevidad. MÉTODO Y RESULTADOS: Realizamos una revisión de la literatura en combinación con nuestra experiencia. En la mujer embarazada se producen una serie de cambios anatómicos y funcionales que van a condicionar no sólo un mayor riesgo de infección urinaria sino, además, una dificultad añadida en su tratamiento debido a las alteraciones en la farmacocinética de los antimicrobianos y a la posible toxicidad para el feto. Pese a los intentos por encontrar un método rápido, fiable y barato de diagnóstico de la bacteriuria de la embarazada, el urocultivo sigue ocupando el primer lugar en la detección y seguimiento de la IU en la gestante. En su tratamiento, los derivados de la penicilina y las cefalosporinas mantienen una posición de privilegio por su demostrada falta de efectos secundarios tanto para la madre como para el feto. Otros fármacos como el aztreonam o la fosfomicina, a pesar de su escasa toxicidad, precisan de más estudios que avalen su idoneidad en el tratamiento de la IU de la embarazada. Las IU de la mujer menopáusica presentan unas características propias que las diferencian de las que se producen en mujeres más jóvenes. Las alteraciones hormonales derivadas de la atrofia gonadal comportan cambios funcionales en el ecosistema vaginal que lo hacen más propenso a la colonización por enterobacterias como primer escalón en el ascenso de éstas hacia el tracto urinario inferior. Esto unido a las alteraciones anatómicas del tracto génito-urinario inherentes a las etapas más avanzadas de la vida de las mujeres hace que la IU sea un problema de una extraordinaria prevalencia en un segmento de población creciente. Las líneas de tratamiento se enfocan, hoy en día, hacia la corrección de estas alteraciones hormonales así como a la prevención mediante una correcta profilaxis antimicrobiana o, en un futuro próximo, a la inmunización mediante vacunas. CONCLUSIÓN: Las infecciones urinarias durante el embarazo y la menopausia tienen diferentes características que requieren diagnósticos y tratamientos diferentes (AU)

[Treatment with shock-wave lithotripsy in children: our experience]. / Tratamiento con litotricia extracorpórea por ondas de choque en niños: nuestra experiencia.

OBJECTIVES: To analyze the efficacy and complication rates of extracorporeal shock wave lithotripsy in the paediatric age group. PATIENTS AND METHODS: From 1989 to 2000, 29 children (mean age 8 years, range 1-14) underwent ESWL for urinary calculi at our institution. A total of forty-four ESWL sessions were performed in 36 calculi and a previous double pigtail stent was inserted in 11 patients. Intravenous anesthesia was used in the vast majority of cases. RESULTS: Complete removal of all stone fragments was achieved in 24 (66.7%) renal units after a first session, 6 (16.7%) after a second session. The rest of the patients became stone-free after 3 sessions in 3 patients, open lithotomy in 1 patient and ureteroscopy in another patient. In one case a watchful waiting was decided after the failure of the first session of ESWL. Mean hospital stay was 3.2 days (range 1-11) for each session. Complications appeared in 10 patients: 4 had renal colic, 3 haematuria, 2 fever and 1 subcutaneous hematoma. CONCLUSIONS: ESWL is a safe and effective treatment for paediatric urolithiasis so it should be considered the first-line treatment.

Tratamiento con litotricia estracorpórea por ondas de choque en niños: nuestra experiencia / Extracorporeal shock wave lithotripsy in children: our experience

OBJETIVOS: Analizar los resultados y complicaciones del tratamiento mediante litotricia extracorpórea por ondas de choque (LEOC) en pacientes pediátricos.PACIENTES Y MÉTODOS: Entre 1989 y 2000 hemos asistido mediante LEOC un total de 29 pacientes pediátricos afectos de litiasis urinaria, con una media de edad de 8 años (rango 1-14 años). Se han tratado un total de 36 unidades litiásicas para lo que se han necesitado 44 sesiones de LEOC, con colocación de catéter doble J previo en 11 pacientes. Se utilizó anestesia general en la mayoría de casos.RESULTADOS: El n° de unidades litiásicas resueltas tras la primera sesión fue de 24 (66,7 por ciento), y tras la segunda sesión 6 (16,7 por ciento). El resto se resolvieron mediante una tercera sesión de ESWL. en tres casos, uno con cirugía abierta v otro litotricia con láser. Un paciente no recibió más tratamientos tras el fracaso de la LEOC. La media de estancia hospitalaria, dada la necesidad de anestesia general, fue de 3,2 días (rango 1-11 días) por sesión. Las complicaciones fueron poco importantes y muy poco frecuentes, apareciendo por orden de frecuencia: dolor cólico, hematuria, fiebre y hematoma subcutáneo. No se detectaron alteraciones de la función renal o cambios anatómicos después de la LEOC en relación a la situación previa.CONCLUSIONES: El tratamiento de la litiasis renal en niños mediante LEOC es un tratamiento seguro y eficaz, considerado de primera elección (AU)

[Treatment of calcium kidney lithiasis. ESWL, NLP, open surgery]. / Tratamiento de la litiasis renal cálcica. LEOC, NLP, cirugía abierta.

OBJECTIVE: To review current management of renal calcium stones. METHODS: Data from our experience are presented and the literature is reviewed. The results and indications of treatment are analyzed. RESULTS/CONCLUSIONS: Pyelic calculi are the best indication for ESWL. The success rate ranges from 33%-90% and is influenced particulary by stone size and composition. Similar results are achieved for calyceal calculi, although the overall complete resolution rate is 50%-75% for stones in the lower calyces versus 90% for PNL. Furthermore, the resolution rate is even lower if the infundibulo-pyelic angle is less than 90 degrees. The resolution rate ranges from 4%-58% for intradiverticular calculi and the best results are obtained when the calculus is small and the neck of diverticulum can be visualized at urography. The staghorn stone is the most complex and offers more difficulties to treatment by ESWL. Good results are achieved only in the staghorn type I (72% resolution; mean 3.5 sessions per patient).

[The treatment of ureteral lithiasis with a pulsed dye laser]. / Tratamiento de la litiasis ureteral con láser pulsado colorante.

PURPOSE: Pulsed dye laser lithotripsy has shown to be an effective and safe procedure for treatment of ureteral calculi. We report our experience. MATERIAL AND METHODS: A total of 1000 patients were treated with pulsed dye laser between January 1990 and February 1996. In 450 patients the procedure was performed under general or regional anaesthesia; the remaining 550 patients were treated with the aid of a mild sedation. RESULTS: In the mild sedation group a total of 417 out of 550 patients (75.8%) had their calculi completely cleared (85.6% of effectiveness in women with pelvic lithiasis). Different facts caused the treatment to fail in the remaining patients: severe pain, vagal reaction and technical difficulties. In the anesthesia group the procedure was effective in 346 cases (76.9%). Laser failed to clear calculi in 104 patients in this group due to technical impossibility and persistence of ureteral fragments. Additional treatment options in order to achieve resolution of the calculi were: ESWL, both ESWL and laser, Dormia basket, Zeiss stent, three-prong grasping forceps, ureterolithotomy and nephrectomy. Morbidity was higher in the group treated under anesthesia, being haematuria the most frequent adverse effect. CONCLUSIONS: We believe that ureteroscopy and laser lithotripsy is an effective, safe and low morbidity procedure for the treatment of ureteral calculi in women with distal calculi. It is often suitable to perform it with mild sedation with the subsequent benefit for both the patient and health care system regarding to cost-effectiveness balance.