Posicionamiento de la Asociación Española de Urología ante el documento de la Sociedad Española de Oncología Médica sobre la administración de tratamientos médicos a los pacientes oncológicos / Positioning statement of the Spanish Association of Urology on the document published by the Spanish Society of Medical Oncology about the use of medical treatments in oncological patients

No disponible

Factores que influyen en los resultados urodinámicos de la toxina botulínica en el tratamiento de la hiperactividad neurógena / Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity

Objetivos: Determinar la eficacia urodinámica y los factores que influyen en los resultados urodinámicos del tratamiento de la hiperactividad neurógena del detrusor con inyección intradetrusoriana de toxina botulínica tipo A (TXB-A) en pacientes con lesión medular (LM). Material y métodos: Se realizó un estudio retrospectivo en una cohorte de 70 pacientes formada por 40 varones y 30 mujeres con LM estable de 39 ± 13,3 años de edad (media ± desviación típica), sometidos a inyección intradetrusoriana de 300 UI de TXB-A. Se realizó un estudio urodinámico previo y otro a los 6 ± 4,3 meses del tratamiento. Posteriormente se realizaron nuevos estudios urodinámicos hasta un intervalo de 16 ± 12,2 meses. Resultados: La TXB-A aumentó significativamene (p < 0,05) la capacidad vesical cistomanométrica, el volumen vesical de la primera contracción involuntaria del detrusor y el residuo posmiccional. Se observó una disminución con tendencia hacia la significación estadística (p < 0,1) de la presión máxima miccional del detrusor y el flujo miccional máximo. No varió significativamente la acomodación vesical ni el índice de resistencia uretral (BOOI). El aumento de la capacidad vesical se mantuvo en el 50% de la muestra más de 32 meses. La edad, el sexo, el tratamiento anticolinérgico y la antigüedad de la lesión no mostraron influencia respecto del aumento de la capacidad vesical. La sonda a permanencia (SVP) fue el único factor negativo estadísticamente significativo. Conclusiones: El efecto urodinámico de la TXB-A se mantiene durante un considerable intervalo de tiempo. La SVP influye negativamente en el resultado del tratamiento

Objectives: To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). Material and methods: A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. Results: The BTX-A significantly increased (p < .05) the cystomanometric bladder capacity, the bladder volume of the first involuntary contraction of the detrusor and the postvoid residue. We observed a decrease that tended towards statistical significance (p < .1) of the maximum detrusor pressure and the maximum urine flow. Neither the bladder accommodation nor the urethral resistance index (bladder outlet obstruction index) varied significantly. The increase in vesical capacity was maintained in 50% of the sample for more than 32 months. Age, sex, anticholinergic treatment and lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. Conclusions: The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment

Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity.

OBJECTIVES: To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). MATERIAL AND METHODS: A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. RESULTS: The BTX-A significantly increased (p < .05) the cystomanometric bladder capacity, the bladder volume of the first involuntary contraction of the detrusor and the postvoid residue. We observed a decrease that tended towards statistical significance (p < .1) of the maximum detrusor pressure and the maximum urine flow. Neither the bladder accommodation nor the urethral resistance index (bladder outlet obstruction index) varied significantly. The increase in vesical capacity was maintained in 50% of the sample for more than 32 months. Age, sex, anticholinergic treatment and lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. CONCLUSIONS: The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment.

Bladder cancer in Spain 2011: population based study.

PURPOSE: We estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study. MATERIALS AND METHODS: Using the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population. RESULTS: A total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases. CONCLUSIONS: The incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.

Estudio de la influencia de los prolapsos pélvicos en la fase miccional del tracto urinario inferior femenino / Study of the Influence of Pelvic Prolapse in the Lower Urinary Tract Micturation Phase in the Female

Objetivos: El prolapso de suelo pélvico es una patología frecuente en la mujer, que además de alteraciones anatómicas puede ocasionar disfunción del tracto urinario inferior. Se pretende comprobar las alteraciones de la fase miccional en pacientes con prolapso pélvico. Material y métodos: Se realizó un estudio transversal de corte en una serie de 102 mujeres con una edad media de 66,8 años (desviación típica: 9,6 años), diagnosticadas de obstrucción urinaria y prolapso pélvico, y un estudio longitudinal prospectivo en una cohorte de 21 pacientes de la anterior serie intervenidas del prolapso. Las pacientes fueron sometidas a exploración clínica para determinar el tipo y grado de prolapso pélvico y a estudio urodinámico. Resultados: Se observó una correlación significativa directa entre el grado del cistocele y el del prolapso uterino, y una correlación significativa pero de sentido inverso entre el grado del prolapso uterino y el del enterocele. Las pacientes con mayor grado de prolapso uterino presentaban mayor resistencia uretral medida por el parámetro URA (resistencia uretral). Se observó una tendencia hacia la significación respecto de la variación poscirugía de los parámetros URA, que disminuyó después de la cirugía, y W80-20 (contractilidad detrusor), que aumentó después de la misma. Conclusiones: Los prolapsos pélvicos afectan a la fase miccional. Esta afectación se produce tanto en el caso de los cistoceles, como en los prolapsos uterinos y del compartimiento posterior (rectocele y enterocele). Además, se observa una mejoría de la contractilidad vesical con la cirugía del prolapso pélvico (AU)

Objectives: Pelvic floor prolapse is a frequent condition in the woman, which in addition to anatomical alterations, may cause lower urinary tract dysfunction. We intend to verify the alterations of the micturation phase in patients with pelvic prolapse. Material and methods: A cross-sectional cut off study was performed in a series of 102 women, mean age 66.8 years (standard deviation 9.6 years), diagnosed of urinary obstruction and pelvic prolapse and a prospective longitudinal study in a cohort of 21 patients of the previous series operated on for the prolapse. The patients were subjected to clinical examinations to determine the type and grade of public prolapse and to a urodynamic study. Results: A significant direct correlation was observed between the grade of cystocele and uterine prolapse and a significant correlation, but in inverse sense, between the grade of uterine prolapse and that of the enterocele. The patients with a greater grade of uterine prolapse had greater urethral resistance by the URA parameter. A tendency towards significance regarding the postsurgical variation of the Urethral Resistance Average (URA) that decreased after the surgery, and the W80-20 (detrusor contractility), that increased after it, was observed. Conclusions: Pelvic prolapses affect the micturation phase. This involvement occurs both in the case of the cystoceles as well as in uterine prolapses and in the posterior compartments (rectocele and enterocele). Furthermore, an improvement is observed in the bladder contractility with the surgery of the pelvic prolapse (AU)

[Study of the influence of pelvic prolapse in the lower urinary tract micturation phase in the female]. / Estudio de la influencia de los prolapsos pélvicos en la fase miccional del tracto urinario inferior femenino.

OBJECTIVES: Pelvic floor prolapse is a frequent condition in the woman, which in addition to anatomical alterations, may cause lower urinary tract dysfunction. We intend to verify the alterations of the micturation phase in patients with pelvic prolapse. MATERIAL AND METHODS: A cross-sectional cut off study was performed in a series of 102 women, mean age 66.8 years (standard deviation 9.6 years), diagnosed of urinary obstruction and pelvic prolapse and a prospective longitudinal study in a cohort of 21 patients of the previous series operated on for the prolapse. The patients were subjected to clinical examinations to determine the type and grade of public prolapse and to a urodynamic study. RESULTS: A significant direct correlation was observed between the grade of cystocele and uterine prolapse and a significant correlation, but in inverse sense, between the grade of uterine prolapse and that of the enterocele. The patients with a greater grade of uterine prolapse had greater urethral resistance by the URA parameter. A tendency towards significance regarding the postsurgical variation of the Urethral Resistance Average (URA) that decreased after the surgery, and the W80-20 (detrusor contractility), that increased after it, was observed. CONCLUSIONS: Pelvic prolapses affect the micturation phase. This involvement occurs both in the case of the cystoceles as well as in uterine prolapses and in the posterior compartments (rectocele and enterocele). Furthermore, an improvement is observed in the bladder contractility with the surgery of the pelvic prolapse.

Coincidence lattices in the hyperbolic plane.

The problem of coincidences of lattices in the space R(p,q), with p + q = 2, is analyzed using Clifford algebra. We show that, as in R(n), any coincidence isometry can be decomposed as a product of at most two reflections by vectors of the lattice. Bases and coincidence indices are constructed explicitly for several interesting lattices. Our procedure is metric-independent and, in particular, the hyperbolic plane is obtained when p = q = 1. Additionally, we provide a proof of the Cartan-Dieudonné theorem for R(p,q), with p + q = 2, that includes an algorithm to decompose an orthogonal transformation into a product of reflections.

[Inverted urothelial papilloma: our clinical experience]. / Papiloma invertido urotelial: nuestra experiencia clínica.

UNLABELLED: A study of inverted urothelial papilloma in our area. METHODS: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. RESULTS: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. CONCLUSIONS: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor.

Papiloma invertido urotelial: nuestra experiencia clínica / Inverted urothelial papilloma: Our clinical experience

Estudio de los papilomas invertidos uroteliales en nuestra área. Material y métodos: Realizamos un estudio de los papilomas invertidos uroteliales diagnosticados en nuestro centro entre enero de 1994 y diciembre de 2007. Se realizó un estudio retrospectivo y prospectivo con análisis estadístico descriptivo: antecedentes urológicos, motivo de consulta, método diagnóstico, focalidad tumoral, método de seguimiento, pronóstico y recurrencia. Se realizó un estudio estadístico con el software SPSS versión 13. Resultados: En el período de estudio se han diagnosticado 14 papilomas invertidos, con una mediana de 59 años. El motivo de consulta fue hematuria en 7 enfermos (50%), seguido de dolor lumbar en 2 enfermos (14,28%) y de síndrome irritativo en 1 enfermo (7,14%), fue diagnosticado en 4 enfermos (28,5%) de manera incidental. Durante el período de seguimiento sólo se produjo una recidiva/recurrencia en un tumor de bajo grado. Conclusiones: El pronóstico, la recurrencia y el potencial de malignización de este tumor no están claros, existiendo controversias en la literatura médica mundial, hecho por el cual aunque desde nuestro punto de vista su naturaleza es benigna, aconsejamos un seguimiento como si se tratase de un tumor urotelial de bajo grado (AU)

A study of inverted urothelial papilloma in our area. Methods: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. Results: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. Conclusions: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor (AU)

SimulaTEM: multislice simulations for general objects.

In this work we present the program SimulaTEM for the simulation of high resolution micrographs and diffraction patterns. This is a program based on the multislice approach that does not assume a periodic object. It can calculate images from finite objects, from amorphous samples, from crystals, quasicrystals, grain boundaries, nanoparticles or arbitrary objects provided the coordinates of all the atoms can be supplied.

On the interpretation of the forbidden spots observed in the electron diffraction patterns of flat Au triangular nanoparticles.

In many cases nanostructures present forbidden spots in their electron diffraction patterns when they are observed by transmission electron microscopy (TEM). To interpret their TEM and high resolution transmission electron microscopy (HRTEM) images properly, an understanding of the origin of these spots is necessary. In this work we comment on the origin of the forbidden spots observed in the [111] and [112] electron diffraction patterns of flat gold triangular nanoparticles. The forbidden spots were successfully indexed as corresponding to the first laue Zone (FOLZ) and the HRTEM images presented a contrast produced by the interference of the zero-order Laue zone (ZOLZ) and FOLZ spots. We discuss the use of the forbidden spots in the study of the structure of nanoparticles and show that they are related to the shape and incompleteness of layers in the very thin particles.

Simplified dynamic model for the motility of irregular echinoids.

Inspired by the locomotion mechanism of sea urchins, we study the locomotion of an irregular echinoid by means of a simplified dynamical model. We prove that if two conjectures are assumed, the geometrical arrangement of the five ambulacral petals of irregular echinoids should form a eutactic star in order to optimize motility. We firstly propose an adequate "measure" of eutacticity that allows us to to verify the statistical tendency to such a property for a representative collection of fossil specimens. Next, regarding dynamics, the biological advantage of eutactic stars is addressed as a minimal path problem. Finally, we study the stability of some eutactic stars under small perturbations.

Polyhedral truncations as eutactic transformations.

An eutactic star is a set of N vectors in Rn (N > n) that are projections of N orthogonal vectors in RN. First introduced in the context of regular polytopes, eutactic stars are particularly useful in the field of quasicrystals where a method to generate quasiperiodic tilings is by projecting higher-dimensional lattices. Here are defined the concepts of eutactic transformations (as mappings that preserve eutacticity) and of vector radiations (vectors that stem from the vectors of an eutactic star), which are used to describe and parameterize polyhedral truncations. The polyhedral truncations preserve eutacticity, a result of relevance to the faceting and habit-forming characteristics of quasicrystals.

[Penile cutaneous horn. Report of a case and review of the literature]. / Cuerno cutáneo peneano. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To describe an additional case of cutaneous penile horn, an uncommon lesion that has been associated with penile neoplasia, particularly epidermoid carcinoma. METHODS/RESULTS: Herein we describe a patient with cutaneous horn of the penis that had presented several years earlier. The patient underwent wide resection and biopsy of the tumor site. To date, no signs of tumor recurrence have been observed. The literature is reviewed. CONCLUSIONS: Cutaneous horn of the penis is an uncommon lesion, but it must be emphasized that it can progress to squamous cell carcinoma. Biopsy of the tumor site should be performed carefully and patients should undergo regular control evaluation.

El valor de la tomografía axial computada como elemento diagnóstico en las lesiones acetabulares / The utility of computerized tomography in diagnosis of acetabular fractures

El presente estudio trata de demostrar la importancia de la tomografía axial computada como el elemento diagnóstico más preciso en los pacientes con fracturas de acetábulo, debido a que los estudios radiográficos convencionales no logran demostrar con precisión la existencia de fragmentos intraarticulares ni la disposición de los mismos y su tamaño, por lo cual se estudiaron los pacientes con diagnóstico de fracturas del acetábulo del tipo II y en adelante (Thompson y Epstein) por un periodo de dos años, 1996 y 1997. En esta serie de 28 casos identificamos que los estudios simples sólo logran identificar de grosso modo la lesión de los elementos anatómicos que conforman el acetábulo. La tomografía por otra parte permitió identificar en el total de nuestros pacientes, la localización exacta de las lesiones y la o las regiones anatómicas afectadas. De esa forma logramos identificar la pérdida de congruencia articular o su estabilidad y la presencia de fragmentos articulares con gran precisión. Además de su disposición dentro o fuera de la articulación resalta la importancia de poder precisar el tamaño de los mismos, lo que permite una evaluación del tipo de lesiones del tratamiento más preciso para cada caso del diagnóstico más temprano y por consecuencia el tratamiento precoz. Ello determina en conjunto una forma por demás importante de la evolución y pronóstico de los pacientes con este tipo de lesiones

[Major outpatient surgery in urology: our experience]. / Cirugía mayor ambulatoria en Urología: nuestra experiencia.

OBJECTIVES: This paper describes our MAS (major ambulatory surgery) unit and its application in urology. METHODS: We reviewed our series of 415 patients seen over a period of 14 months; of these, 71 (17%) did not meet the criteria and the remaining 344 patients (83%), with ages ranging from 6 months to 78 years, were treated in our MAS unit. Surgery was performed for circumcision, cryptorchidism, PVCP and hydrocele. RESULTS: Only 2 (0.5%) of the patients were hospitalized and 5 (1.4%) were reoperated. The degree of patient satisfaction was over 90%. CONCLUSIONS: 1. MAS is efficacious in providing care and efficiently resolves difficult urological cases. 2. Patient satisfaction is very high and there were only a few complications in the patients treated in this unit.

[Segment resection of the ureter in transitional cell carcinoma]. / Resección segmentaria de uréter en carcinoma transicional.

OBJECTIVE: Although it is not the treatment of choice, conservative surgery by segmental resection of the ureter has achieved very good results in a patient with transitional cell carcinoma of the ureter. These results prompted us to report on the present case. METHODS/RESULTS: Diagnosis was fundamentally by IVP. Treatment by partial resection of the ureter achieved good results as shown by the postoperative control evaluation and follow up. CONCLUSIONS: Although nephroureterectomy continues to be the treatment of choice in transitional cell carcinoma of the urinary tract, conservative treatment (endoscopic resection of the tumor) may achieve good results in some selected cases. If conservative surgery is performed, the patient must be followed very closely using urine cytology, IVP or ureteroscopy.