[Urinary lithiasis. The patient also plays.] / Urolitiasis: el paciente también juega.

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis' patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way.

Urolitiasis: el paciente también juega / Urinary lithiasis. The patient also plays

La litiasis renal es conocida por su alta incidencia y prevalencia, pero sobre todo por su morbilidad y recurrencia. A pesar de una buena indicación y un tratamiento quirúrgico apropiado, el problema de fondo, es decir el origen la formación de los cálculos, normalmente sigue existiendo y no es raro que los pacientes sufran múltiples tratamientos y molestias secundarias a las maniobras auxiliares que normalmente empleamos para prevenir complicaciones. Es de sobra sabido, por coherente, que un tratamiento profiláctico con medidas generales o, en un menor grupo de pacientes, específicas son convenientes para disminuir las recidivas. Sin embargo, la profilaxis no suele ser empleada por una buena parte de los urólogos y, por si fuera poco, en una buena parte de aquellos casos en los que sí se tiene en cuenta, es el paciente el que falla por inadecuada adherencia al tratamiento. Es de gran importancia, en cualquiera de las conversaciones con el paciente litiásico relacionadas con su enfermedad, que el urólogo le proporcione una correcta y detallada información sobre todos los aspectos de la misma, desde el diagnóstico al tratamiento activo y posibles complicaciones y, desde luego en aquellos casos en los que la profilaxis vaya a ser fundamental para evitar nuevos episodios desagradables de dolor e intervenciones quirúrgicas asociadas, haciendo hincapié en que del propio paciente depende, en buena medida, que mejore su calidad de vida. En este artículo se pretende enumerar aquellas actitudes que debemos tener en cuenta, contando con la evidencia existente y la experiencia personal, para facilitar al paciente tanto las decisiones terapéuticas como una actitud positiva del mismo hacia su propia enfermedad, con el propósito de controlarla de la mejor manera posible

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis´ patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way

An Arterial Based Complexity (ABC) Scoring System to Assess the Morbidity Profile of Partial Nephrectomy.

BACKGROUND: Tumor characteristics affect surgical complexity and outcomes of partial nephrectomy (PN). OBJECTIVE: To develop an Arterial Based Complexity (ABC) scoring system to predict morbidity of PN. DESIGN, SETTING, AND PARTICIPANTS: Four readers independently scored contrast-enhanced computed tomography images of 179 patients who underwent PN. INTERVENTION: Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Scores of 1, 2, 3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Linear regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, and estimated glomerular filtration rates at 6 wk and 6 mo after surgery adjusted for baseline estimated glomerular filtration rate. Fisher's exact test was used to test for differences in risk of urinary fistula formation by reference category assignment. RESULTS AND LIMITATIONS: Pairwise comparisons of readers' score assignments were significantly correlated (all p<0.0001); average kappa = 0.545 across all reader pairs. The average proportion of exact matches was 69%. Linear regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and ischemia time (p<0.0001) and estimated blood loss (p=0.049). Fisher's exact test showed a significant difference in risk of urinary fistula formation with higher reference category assignments (p=0.028). Limitations include use of a single institutional cohort to evaluate our system. CONCLUSIONS: The ABC scoring system for PN is intuitive, easy to use, and demonstrated good correlation with perioperative morbidity. PATIENT SUMMARY: The ABC scoring system is a novel anatomy-reproducible tool developed to help patients and doctors understand the complexity of renal masses and predict the outcomes of kidney surgery.

Influencia de la curva de aprendizaje en el diagnóstico del cáncer de próstata mediante biopsia ecodirigida / Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy

OBJETIVO: Analizar si existe una curva de aprendizaje hasta lograr realizar biopsias prostáticas ecodirigidas de alta calidad que permitan efectuar el diagnóstico de cáncer de próstata con eficacia, teniendo en cuenta el resultado anatomopatológico de las muestras. MÉTODOS: Se revisaron retrospectivamente los datos de las 790 biopsias de próstata ecodirigidas realizadas en nuestro servicio entre mayo de 2009 y diciembre 2012 por cuatro cirujanos de modo consecutivo. Se revisaron los siguientes datos: cirujano que la realizaba, fecha de realización, edad del paciente, PSA, tacto rectal, ecografía, volumen prostático, número de cilindros recogidos y resultado anatomopatológico de la biopsia. Los cirujanos eran médicos internos residentes de urología en su primer año en nuestro servicio. Para el análisis estadístico se agruparon las biopsias en bloques de 25 y 75 casos realizados por cirujano, ordenados cronológicamente. Para valorar la influencia de la curva de aprendizaje en el diagnóstico se realizó un análisis univariante y multivariante entre las distintas variables y el resultado anatomopatológico. RESULTADOS: La mediana de edad fue 67 años (42-90). Fueron positivas para cáncer de próstata 300 biopsias (38%). En el análisis univariante respecto a la tasa de detección de cáncer, las variables cirujano, PSA, tacto rectal, resultado ecográfico, volumen prostático, número de cilindros y grupos de 75 mostraron diferencias estadísticamente significativas, esta última mostró un porcentaje de 32% en las primeras 75 biopsias realizadas por los cirujanos y 43,2% en el último grupo. No las mostraron las variables edad (p = 0,11) y grupos de 25 pacientes (p = 0,07). En el análisis multivariante, sin embargo, únicamente fueron estadísticamente significativas las variables PSA, tacto rectal, volumen prostático y grupos de 75 pacientes, esta última con una OR de 1,35 (IC95% 1,09 - 1,66). CONCLUSIONES: Los resultados obtenidos en nuestro estudio muestran que sí influye el número de procedimientos realizados, es decir la experiencia del cirujano, para alcanzar una rentabilidad diagnóstica óptima en las biopsias de próstata ecodirigidas

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p = 0.11) and groups of 25 patients (p = 0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies

[Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy]. / INFLUENCIA DE LA CURVA DE APRENDIZAJE EN EL DIAGNÓSTICO DEL CÁNCER DE PRÓSTATA MEDIANTE BIOPSIA ECODIRIGIDA.

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p=0.11) and groups of 25 patients (p=0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies.

Cysticlean® a highly pac standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study.

BACKGROUND: The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). METHODS: This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. RESULTS: The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P<0.0001), which represent a 93% improvement. At baseline, the mean score on the VAS scale (range from 0 to 100) for assessing the QoL was 62.4±19.1, increasing to 78.2±12.4 at Month 6 (P=0.0002), which represents a 20% improvement. All patients had an infection with positive urine culture at baseline, after 6 months there were only 3 symptomatic infections (P<0.001). The most common bacterium was Escherichia coli. CONCLUSIONS: Prophylaxis with American cranberry extract (Cysticlean®) could be an alternative to classical therapies with antibiotics. Further studies are needed to confirm results obtained in this pilot study.