Factores de riesgo preoperatorios en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía.

OBJETIVO: Identificar factores de riesgo asociados a complicaciones mayores en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. MÉTODO: Análisis retrospectivo de expedientes clínicos de pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. Se analizaron el sexo, el índice de masa corporal, el índice de comorbilidad de Charlson, la clasificación del estado físico de la American Society of Anesthesiologists, la etapa de Malek, el conteo leucocitario y los valores de creatinina. Las complicaciones se estratificaron en menores y mayores según la clasificación de Clavien-Dindo. Se realizó análisis univariado y bivariado usando las pruebas exacta de Fisher y ji al cuadrado de Pearson, y se establecieron medidas de riesgo utilizando la odds ratio (OR). RESULTADOS: Se analizaron 72 pacientes con una edad media de 50 años, el 83% mujeres, el 58.3% con urocultivo positivo y el 66% con litiasis renal. El 32% tuvieron alguna complicación mayor y el 15% requirieron admisión a la unidad de cuidados intensivos. Los valores elevados de creatinina (OR: 3.8; intervalo de confianza del 95% [IC95%]: 1.1-13; p = 0.02) y la etapa Malek II-III (OR: 4.5; IC95%: 1.2-17.5; p = 0.02) se asociaron con complicaciones mayores. CONCLUSIÓN: El estadio de Malek y los valores elevados de creatinina incrementan el riesgo de desarrollar complicaciones mayores en los pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomía. OBJECTIVE: To identify preoperative risk factors associated with major complications in patients with xanthogranulomatous pyelonephritis undergoing total nephrectomy. METHOD: Retrospective analysis of patient's charts with xanthogranulomatous pyelonephritis who underwent nephrectomy. Risk factors included for analysis were gender, body mass index, Charlson comorbidity index, American Society of Anesthesiologists physical status classification, Malek's stage, leukocyte count and creatinine levels. Postoperative complications were stratified in minor and major according to Clavien-Dindo's classification. Univariate and bivariate analysis using Fisher's exact test, Pearson's chi-squared and odds ratio (OR) was performed. RESULTS: 72 patients were analyzed, 83% women, mean age of 50 years, 58.3% positive urine cultures and 66% kidney stones. Major complications were present in 32% of cases, and 15% were admitted to the intensive care unit. Elevated creatinine (OR: 3.8; 95% confidence interval [95%CI]: 1.1-13; p = 0.02) and Malek's stage II to III (OR: 4.5; 95%CI: 1.2-17.5; p = 0.02) were associated with major complications. CONCLUSION: The Malek Stage and elevated creatinine increases the risk of major complications in patients undergoing nephrectomy due to xanthogranulomatous pyelonephritis.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser.

INTRODUCTION: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. OBJECTIVE: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. METHOD: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. RESULTS: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. CONCLUSIONS: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

INTRODUCCIÓN: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. OBJETIVO: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. MÉTODO: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. RESULTADOS: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. CONCLUSIONES: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser / Predictors of stone-free status in the first flexible ureteroscopy with laser lithotripsy

Resumen Introducción: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. Objetivo: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. Método: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. Resultados: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. Conclusiones: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Abstract Introduction: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. Objective: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. Method: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. Results: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. Conclusions: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

[Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea].

Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea / Stone-free rate without major complication as a definition of success in percutaneous nephrolithotomy

Resumen Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Abstract Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Rearrangement of the Guy's stone score improves prediction of stone-free rate after percutaneous nephrolithotomy.

OBJECTIVE: We propose a modification of the original Guy's Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone- free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups. RESULTS: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). CONCLUSION: The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

[Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms]. / Tamsulosin, oxybutynin or their combination in the treatment of ureteral stent-related symptoms.

BACKGROUND: The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). METHODS: Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05. RESULTS: 170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms. CONCLUSIONS: Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.

OBJETIVO: comparar la eficacia de tamsulosina, oxibutinina o su combinación para el tratamiento de los síntomas relacionados con el uso de catéter doble J (CJJ). MÉTODOS: ensayo clínico aleatorizado, no cegado, de tres brazos (tamsulosina, oxibutinina o la combinación), para evaluar la mejoría de los síntomas asociados a CJJ con el cuestionario de síntomas asociados a catéteres ureterales (USSQ) y los efectos adversos del tratamiento. Las evaluaciones se hicieron a los 7 y 21 días de colocado el CJJ. Las maniobras se compararon mediante Chi cuadrada, Kruskall-Wallis, ANOVA y Wilcoxon, considerando estadísticamente significativa una p ≤ 0.05. RESULTADOS: se evaluaron 170 pacientes con CJJ. El análisis se realizó por protocolo con 142 pacientes, 53 recibieron tamsulosina (37.4%), 42 oxibutinina (29.6%) y 47 la combinación de ambos (33%). A los 7 y 21 días la mejoría fue similar en los tres brazos. Los hombres con tamsulosina y las mujeres con oxibutinina tuvieron menos síntomas generales. CONCLUSIONES: la tamsulosina, oxibutinina o su combinación mejoran de manera similar los síntomas por CJJ y esta mejoría se hace más notoria a través del tiempo. Los hombres están menos sintomáticos con tamsulosina y las mujeres con oxibutinina.

[Stone free rate assesment after percutaneous nephrolithotomy using nephrolitometric nomogram]. / Evaluación de la tasa libre de litos posterior a la nefrolitotomía percutánea mediante el nomograma nefrolitométrico.

BACKGROUND: Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction. OBJECTIVES: To evaluate the stone-free rate in patients undergoing percutaneous nephrolithotomy with the Clinical Research Office of the Endourological Society nomogram and suggest modifications to improve the classification. MATERIAL AND METHODS: We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3groups: i from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskall-Wallis test was performed, p<0.05). RESULTS: A total of 126 patients were included. According to the nehrolithometric nomogram the stone-free rate was 12.5% for patients with fewer than 111 points and 70.9% for those with 111 points or more. In the modification proposed for groups I, IIand III the stone-free rate was 12.5%, 50% and 80% respectively (p=0.000). CONCLUSIONS: Evaluation using the nephrolithometric nomogram demonstrated accurate stone-free rate prediction for complex and simple stones, with a lack of discrimination for patients with intermediate scores. Our modification enabled better differentiation of the intermediate groups from the high and low stone-free rate groups.

[Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. / Factores pronósticos de morbimortalidad en pacientes con pielonefritis enfisematosa.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 µL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 µL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

[The use of S.T.O.N.E. scale in patients undergoing percutaneous nephrolithotomy]. / USO DE LA ESCALA DE S.T.O.N.E. EN PACIENTES SOMETIDOS A NEFROLITOTOMÍO PERCUTÁNEA.

OBJECTIVES: The aim of this study was to apply the S.T.O.N.E. scale on our patients undergoing PCNL to predict stone free rate and complications using the modified Clavien scale. METHODS: A historical cohort of patients undergoing PCNL was analyzed. All patients with computed tomography to assess stone-free rate with the S.T.O.N.E. scale and complications were evaluated by the modified Clavien scale. RESULTS: In 102 patients 104 procedures were performed; the mean age was 48.4 years and 71% were women. The distribution of cases were classified as mild: 6.7%, moderate: 63.5% and severe: 29.8%. The stone free rate after the first procedure globally reached 58% and by grade was: mild 85.7%, moderate 71.2% and severe 25%. The RR for residual stones after the first procedure was 2.4 for moderate grade (CI 0.3 to 15, p=0.03) and 4.9 for severe grade (CI 0.7 - 30.9, p=0.08). The overall complication rate was 33%, separately Clavien 1: 14.4%, 2: 9.6%, 3a: 2.9%, 3b: 2.9% 4:1.9%, 5:1%. CONCLUSIONS: The S.T.O.N.E. scale applied in our population can predict accurately and easily stone free rate in patients undergoing PCNL. We found no predictive association for this scale on complications.

Uso de la escala de S.T.O.N.E. en pacientes sometidos a nefrolitotomía percutánea / The use of S.T.O.N.E. scale in patients undergoing percutaneous nephrolithotomy

OBJETIVOS: El objetivo del presente trabajo fue aplicar la escala de S.T.O.N.E. a nuestros pacientes sometidos a NLP para predecir el porcentaje de casos libres de litiasis y complicaciones utilizando la escala de Clavien modificada para NLP. MÉTODOS: Se analizó una cohorte histórica de pacientes sometidos a NLP. Se incluyeron pacientes que contaran con tomografía axial computada para evaluar la tasa libre de litiasis con la escala de S.T.O.N.E. y las complicaciones se evaluaron a través de la escala de Clavien modificada. RESULTADOS: En 102 pacientes se realizaron 104 procedimientos de NLP, la edad promedio fue 48.4 años y el 71% fueron mujeres. La distribución de los casos se clasificaron como grado leve: 6.7%, moderado: 63.5% y severo: 29.8%. La tasa libre de litiasis después de un primer procedimiento en forma global alcanzó el 58% y por grados fue: leve 85.7%, moderado 71.2% y severo 25%. El RR para litiasis residual después del primer procedimiento fue de 2.4 para el grado moderado (IC 0.3 - 15, p = 0.03) y 4.9 para el grado severo (IC 0.7 - 30.9, p = 0.08). La tasa global de complicaciones fue del 33%, para Clavien 1 del 14.4%, 2: 9.6%, 3A: 2.9%, 3B: 2.9%, 4:1.9%, 5:1%. CONCLUSIONES: La escala de S.T.O.N.E. aplicada en nuestra población puede predecir de manera correcta y sencilla la tasa libre de litiasis en pacientes sometidos a nefrolitotomía percutánea. No encontramos asociación predictiva en esta escala para las complicaciones

OBJECTIVES: The aim of this study was to apply the S.T.O.N.E. scale on our patients undergoing PCNL to predict stone free rate and complications using the modified Clavien scale. METHODS: A historical cohort of patients undergoing PCNL was analyzed. All patients with computed tomography to assess stone-free rate with the S.T.O.N.E. scale and complications were evaluated by the modified Clavien scale. RESULTS: In 102 patients 104 procedures were performed; the mean age was 48.4 years and 71% were women. The distribution of cases were classified as mild: 6.7%, moderate: 63.5% and severe: 29.8%. The stone free rate after the first procedure globally reached 58% and by grade was: mild 85.7%, moderate 71.2% and severe 25%. The RR for residual stones after the first procedure was 2.4 for moderate grade (CI 0.3 to 15, p = 0.03) and 4.9 for severe grade (CI 0.7 - 30.9, p = 0.08). The overall complication rate was 33%, separately Clavien 1: 14.4%, 2: 9.6%, 3a: 2.9%, 3b: 2.9% 4:1.9%, 5:1%. CONCLUSIONS: The S.T.O.N.E. scale applied in our population can predict accurately and easily stone free rate in patients undergoing PCNL. We found no predictive association for this scale on complications

[Intrarectal povidone-iodine to reduce the risk of genitourinary infections after transrectal prostate biopsy]. / Iodopovidona intrarrectal y riesgo de infección genito- urinaria posterior a biopsia prostática transrectal.

BACKGROUND: The aim of this study is to compare two different preparations in patients undergoing transrectal prostate biopsies samples (TPBS) and assess the prevalence of genitourinary infections (GUI). METHODS: A historical cohort of patients undergoing TBPS for suspected prostate cancer. Two groups were compared: one with endorectal lubricant jelly and another with the addition of a povidone-iodine lubricating jelly. Complications were evaluated at three weeks. A bivariate analysis was performed by calculating the OR (95 % CI) to determine if the additional endorectal povidone-iodine pre-TBPS reduced GUI and other complications. RESULTS: 185 patients (Group I n = 86, Group II n = 96) were evaluated. 45 and 25 % had genitourinary tract infection (OR: 0.4, CI: 0.2-0.9, p = 0.004); fever was presented in 21 and 10 % respectively (OR: 0.42, CI: 0.1-0.9, p = 0.04). CONCLUSIONS: A reduction was observed in the presence of genitourinary infections in patients who had intrarectal povidone-iodine preparation applied.

Introducción: el objetivo de este estudio es comparar dos preparaciones distintas en pacientes sometidos a la toma de biopsias prostáticas transrectales (BPTR) y evaluar la prevalencia de infecciones genitourinarias (IGU). Métodos: se compararon dos grupos de pacientes con sospecha de cáncer de próstata sometidos a Biopsia Prostática Transrectal (BPTR): Con jalea lubricante endorrectal (grupo l, cohorte histórica) y con jalea lubricante más iodopovidona (grupo II, cohorte prospectiva). Se evaluaron las complicaciones a las tres semanas. Se realizó un análisis bivariado, calculando su OR (IC: 95 %) para determinar si la iodopovidona endorrectal adicional previa a la BPTR disminuye las IGU y otras complicaciones. Resultados: Se evaluaron 185 pacientes (Grupo I n = 86; grupo II n = 96). Tuvieron infección del tracto genitourinario el 45 y 25 % (OR: 0.4, IC: 0.2-0.9, p = 0.004); la fiebre se presentó en el 21 y 10 % respectivamente (OR: 0.42, IC: 0.1-0.9, p = 0.04). Conclusiones: Se observó una reducción en la presencia de infecciones genitourinarias en pacientes a quienes se aplicó en su preparación iodopovidona intrarrectal.

[Developing critical skills to analyze research reports in nuclear medicine]. / Alcances de una estrategia educativa desde una perspectiva participativa de la educación en el desarrollo de lectura crítica de informes de investigación en médicos residentes de medicina nuclear.

OBJECTIVE: To estimate the impact of an educational strategy aimed at developing critical reading of research reports among medical residents enrolled in a nuclear medicine course. METHODS: We carried out an intervention study to measure the degree to which students developed critical reading skills in a one month period (May-June, 2007). We developed an instrument that included five summaries of research articles in nuclear medicine and 96 sentences that measured four indicators (interpret, judge, propose, and assessment of technical and technological aspects). The instrument's internal validity was measured using the Kuder-Richardson test (KR 20 = 0.89) stratified in five scores: very low (17-32), low (33-48), medium (49-64), high (65-80) and very high (81-96). Non-paramentric statistics was employed to determine significant differences. RESULTS: At the beginning of the intervention, 0.80 of participating residents scored in the "very low" domain of critical reading even after controlling for a random effect. At the end of the study, 0.90 scored in the "medium" category. Results were statistically significant (p = 0.02). CONCLUSIONS: The educational strategy tested, fostered the development of critical reading skills among a sample of nuclear medicine residents.

[Urachus cystopexy: new technique for bladder suspension associated to the Burch's technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up]. / Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al Burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo.

OBJECTIVES: To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch's colpopexy versus Burch's colpopexy plus urachus-cystopexy. METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch's colpopexy (group B) and 75 patients underwent Burch's colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005. The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately. RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p = 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p = 0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1% of group B and 19.4% of group BU had UUI (p = 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p = 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p = 0.000) at 12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p = 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately. CONCLUSIONS: Burch's procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch's procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch's procedure.

Alcances de una estrategia educativa desde una perspectiva participativa de la educación en el desarrollo de lectura crítica de informes de investigación en médicos residentes de medicina nuclear / Developing critical skills to analyze research reports in nuclear medicine

Objetivo: Estimar los alcances de una estrategia educativa en el desarrollo de la lectura crítica de informes de investigación en médicos residentes de medicina nuclear. Métodos: Estudio de intervención entre mayo y junio de 2007 para medir el grado de desarrollo de lectura crítica en médicos residentes de medicina nuclear. Se elaboró un instrumento con cinco resúmenes de informes de investigación en medicina nuclear, con 96 enunciados que exploraron cuatro indicadores (interpretar, enjuiciar, proponer y valoración de aspectos técnicos y tecnológicos). Se estimó la confiabilidad interna con la prueba de Kuder-Richardson 20 (0.89). Se conformaron cinco categorías: muy bajo (17-32), bajo (33-48), medio (49-64), alto (65-80) y muy alto (81-96). El análisis estadístico se realizó con estadística no paramétrica. Resultados: Al inicio de la estrategia, 80 % de los residentes mostró un grado de dominio de lectura crítica muy bajo e incluso calificaciones dentro de lo explicable por efecto del azar; al final de la misma, 90% alcanzó un dominio medio. Las diferencias fueron estadísticamente significativas (p=0.02). Conclusiones: La estrategia educativa propició un avance en el desarrollo de lectura crítica de informes de investigación en medicina nuclear.

OBJECTIVE: To estimate the impact of an educational strategy aimed at developing critical reading of research reports among medical residents enrolled in a nuclear medicine course. METHODS: We carried out an intervention study to measure the degree to which students developed critical reading skills in a one month period (May-June, 2007). We developed an instrument that included five summaries of research articles in nuclear medicine and 96 sentences that measured four indicators (interpret, judge, propose, and assessment of technical and technological aspects). The instrument's internal validity was measured using the Kuder-Richardson test (KR 20 = 0.89) stratified in five scores: very low (17-32), low (33-48), medium (49-64), high (65-80) and very high (81-96). Non-paramentric statistics was employed to determine significant differences. RESULTS: At the beginning of the intervention, 0.80 of participating residents scored in the [quot ]very low[quot ] domain of critical reading even after controlling for a random effect. At the end of the study, 0.90 scored in the [quot ]medium[quot ] category. Results were statistically significant (p = 0.02). CONCLUSIONS: The educational strategy tested, fostered the development of critical reading skills among a sample of nuclear medicine residents.

Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo / Urachus cystopexy: New technique for bladder suspension associated to the Burch`s technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up

OBJETIVO: Comparar la eficacia y morbilidad a largo plazo de pacientes con incontinencia urinaria de esfuerzo a las que se realizó uretro-cervico-suspensión tipo Burch versus el procedimiento de Burch más uraco-cistopexia.MÉTODOS: Se realizó un análisis de cohorte retrospectivo, longitudinal, comparativo y observacional. De enero de 1994 a marzo 2005 se incluyeron 129 pacientes con incontinencia urinaria de esfuerzo (IUE) o incontinencia urinaria mixta (IUM). Cincuenta y cuatro pacientes fueron sometidas a procedimiento de Burch (grupo B) y 75 pacientes a procedimiento de Burch asociado a uraco-cistopexia (grupo BU). La severidad de la incontinencia fue valorada mediante el número de apósitos utilizados durante 24 hrs. La cura se consideró cuando el paciente no requirió ningún dispositivo para la pérdida urinaria; la mejoría como una disminución a una toalla al día y fracaso el uso de más de 1 apósito en 24 horas. En la IUM, el componente de incontinencia urinaria de urgencia (IUU) se evaluó por separado(AU)

RESULTADOS: Se evaluaron 47 pacientes del grupo B y 67 pacientes del grupo BU; a los 12 meses de seguimiento observando una tasa cura/mejoría de la IUE del 74.4% (29/6) y 97% (58/7) respectivamente, p=0.001 y a los 24 meses de seguimiento 35 pacientes del grupo B y 42 pacientes del grupo BU observando una tasa del 65.7% (22/3) y 97.6% (37/4) respectivamente, p=0.014. La IUM basal se presentó en 53.7% de pacientes del grupo B y en 58.6% pacientes del grupo BU. Se analizó en forma aislada la parte de IUU de estas pacientes; a los 12 meses 53.1% de pacientes del grupo B y 19.4% del grupo BU presentaban IUU, p=0.000 y a los 24 meses 50% de pacientes del grupo B y 26.19% del grupo BU presentaban IUU, p=0.029. La IUU de novo se presentó en 19.14% de pacientes de grupo B y en el grupo BU 5.97%, p=.0000 y a los 24 meses en el grupo B 17.64% de pacientes y en el grupo BU 13.95% p=0.005. Las complicaciones relacionadas a la uraco-cistopexia se presentaron en el trans-operatorio y fue apertura vesical en 3 de los primeros casos que se resolvieron con cistorrafia en dos planos y sonda vesical por espacio de 7 días.CONCLUSIONES: El procedimiento de Burch asociado a la uraco-cistopexia tuvo mayor eficacia en la resolución a largo plazo de la IUE y del componente de IUU que el procedimiento de Burch aislado. La fijación quirúrgica del uraco a la aponeurosis de los rectos anteriores del abdomen mantiene firme la vejiga, lo que probablemente disminuye su desplazamiento durante los esfuerzos, evitando así la tensión en las fijaciones uretro-cervicales, elevando la eficacia del procedimiento de Burch(AU)

OBJECTIVES: To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch’s colpopexy versus Burch’s colpopexy plus urachus-cystopexy.METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch’s colpopexy (group B) and 75 patients underwent Burch’s colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005.The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately.RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p= 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p=0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1 % of group B and 19.4 % of group BU had UUI (p= 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p= 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p= 0.000) at12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p= 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately(AU)

CONCLUSIONS: Burch’s procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch’s procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch’s procedure(AU)

[Two methods for transrectal ultrasound-guided biopsy of the prostate: systematic vs. guided for suspect echogenic lesion]. / Dos métodos para la toma de biopsia transrectal de próstata ecodirigida: sistemática versus ecosospechosa.

OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.

[Perinephric abscess: associated factors and mortality]. / Absceso perirrenal: factores asociados a su desarrollo y mortalidad.

OBJECTIVES: To determine predisposing factors in perinephric abscesses and to find events associated with unfavourable outcome. METHODS: We carried out a clinical, descriptive, retrospective and cross-sectional study, including 23 patients diagnosed of perinephric abscess admitted to our hospital. RESULTS: In patients with perinephric abscess, clinical charts included diabetes mellitus in 65.2%, history of nephrolithiasis in 43.47% and history of urological surgery in 17.38%. On hospital admission, haemoglobin greater than 10.5 g/dL and white blood cell count lower than 15 x 10(3) / microL were associated with nephrectomy, and platelet count lower than 140 x 10(3) / microL with septic shock. General mortality was 8.69%, and 78.3% if patient required nephrectomy. Patients who died had fever, anaemia, white blood cell count greater than 16 x 10(3) / microL, platelet count lower than 130 x 10(3) / microL, and hyponatremia of 125 mEq/L or lower at hospital admittance, and all of them had septic shock and required nephrectomy. CONCLUSIONS: In our series, a higher percentage of patients had diabetes mellitus and/or nephrolithiasis. Haemoglobin level and white blood cells count were associated with loss of the renal unit, thrombocytopenia was associated with septic shock and hyponatremia with mortality.

Dos métodos para la toma de biopsia transrectal de próstata ecodirigida: sistemática versus ecosospechosa / Two methods for transrectal ultrasound-guided biopsy of the prostate: systematic vs guided for suspect echogenic lesion

OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.

Absceso perirrenal: factores asociados a su desarrollo y mortalidad / Perinephric abscess: associated factors and mortality

Objetivo: Determinar los factores predisponentes para la formación de abscesos perirrenales y encontrar eventos asociados a una evolución desfavorable. Métodos: Realizamos un estudio clínico, descriptivo, retrospectivo y transversal que incluyó 23 pacientes con diagnóstico de absceso perirrenal ingresados en nuestro hospital. Resultados: Las entidades clinicas asociadas con el absceso perirrenal fueron: Diabetes mellitus en 65.2%, antecedente de litiasis renal en 43.47% y el antecedente de cirugia urologica en 17.38%. Al ingreso, la hemoglobina mayor a 10.5 g/dL y leucocitos menores a 15 x 103 / µL se asociaron con mayor frecuencia a nefrectomía y las plaquetas menores a 140 x 103 / µL se asociaron a choque séptico. La mortalidad general fue de 8.69% y 78.3% requirieron nefrectomía. Los pacientes que murieron presentaron al ingreso fiebre, anemia, leucocitosis mayor a 16 x 103 / µL, plaquetas menores a 130 x 103 / µL, sodio sérico menor a 125 mEq/L, requirieron nefrectomía y presentaron choque séptico. Conclusiones: En nuestra serie un buen porcentaje de pacientes con absceso perirrenal son portadores de diabetes mellitus y/o litiasis renal. El nivel de hemoglobina y de leucocitos se asoció con la pérdida de la unidad renal, la trombocitopenia se asoció a choque séptico y la hiponatremia con la mortalidad (AU)

Objectives: To determine predisposing factors in perinephric abscesses and to find events associated with unfavourable outcome. Methods: We carried out a clinical, descriptive, retrospective and cross-sectional study, including 23 patients diagnosed of perinephric abscess admitted to our hospital. Results: In patients with perinephric abscess, clinical charts included diabetes mellitus in 65.2%, history of nephrolithiasis in 43.47% and history of urological surgery in 17.38%. On hospital admission, haemoglobin greater than 10.5 g/dL and white blood cell count lower than 15 x 103 / µL were associated with nephrectomy, and platelet count lower than 140 x 103 / µL with septic shock. General mortality was 8.69%, and 78.3% if patient required nephrectomy. Patients who died had fever, anaemia, white blood cell count greater than 16 x 103 / µL, platelet count lower than 130 x 103 / µL, and hyponatremia of 125 mEq/L or lower at hospital admittance, and all of them had septic shock and required nephrectomy. Conclusions: In our series, a higher percentage of patients had diabetes mellitus and/or nephrolithiasis. Haemoglobin level and white blood cells count were associated with loss of the renal unit, thrombocytopenia was associated with septic shock and hyponatremia with mortality (AU)