Eficacia de la terapia de ondas de choque de baja intensidad para la disfunción eréctil: revisión sistemática y metaanálisis / Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis

Contexto: La terapia con ondas de choque de baja intensidad (OCBI) es una modalidad de reciente uso en el tratamiento de la disfunción eréctil. Objetivo: Evaluar la eficacia de la terapia con OCBI para el tratamiento de la disfunción eréctil según se describe en la literatura. Adquisición de evidencia: Dos revisores independientes identificaron estudios elegibles para llevar a cabo revisión sistemática y metaanálisis de diferentes fuentes escritas en inglés y español, utilizando las bases de datos de PubMed, Embase y Web of Science. Se excluyeron los estudios sobre la enfermedad de Peyronie. Se utilizó el método Der Simonian-Laird para definir la heterogeneidad calculando la desviación estándar de la media (DME) agrupada. El objetivo primario de esta revisión es evaluar la eficacia según el cambio del Índice internacional de función eréctil (IIEF-EF) sobre basal al mes de inicio de tratamiento, tanto para el brazo de tratamiento como para el brazo placebo. El objetivo secundario se centra en analizar IIEF-EF a 3-6 meses tras el inicio de la terapia. Síntesis de evidencia: Los datos agrupados de 636 pacientes procedentes de 12 estudios mostraron que el tratamiento con OCBI conlleva un aumento significativo de IIEF-EF al mes con respecto a basal (DME = -2,92; p = 0,000), en un grado mayor que placebo (DME = -0,99; p = 0,000). El IIEF-EF a 3-6 meses en pacientes tratados fue significativamente mayor que basal (DME = -2,78; p = 0,000). Solo hay un estudio que compara eficacia de placebo a 3-6 meses vs basal (DME = -9,14). La comparación entre OCBI y placebo favorece el tratamiento activo (DME = 2,53; p = 0,000) al mes. No existen datos suficientes para evaluar respuesta sobre placebo a los 3-6 meses en la literatura. Conclusiones: El tratamiento con OCBI para la disfunción eréctil según la literatura resulta eficaz, tanto a corto como a medio plazo. A corto plazo se ha descrito incluso más eficaz que placebo. Los datos sobre eficacia a largo plazo son insuficientes. También se necesitan más estudios para dilucidar el papel de esta terapia según las causas específicas de la disfunción eréctil

Context: The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. Objective: To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. Acquisition of evidence: Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3- 6 months from the start of the therapy. Summary of the evidence: The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P = .000), to a greater degree than placebo (SDM, -.99; P = .000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P = .000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P = .000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months. Conclusions: According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction

Análisis comparativo entre nefrectomía parcial LESS híbrida y laparoscópica convencional multipuerto / Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy

Objetivo: Comparar resultados operatorios y oncológicos de la nefrectomía parcial realizada mediante abordaje laparoendoscópico a través de puerto único (LESS) reutilizable y laparoscópico multipuerto. Material y método: Estudio comparativo prospectivo pareado no aleatorizado de pacientes tratados con nefrectomía parcial mediante abordaje LESS híbrido con trocar auxiliar de 3,5 mm (n = 20) y con laparoscopia multipuerto convencional (n = 26). Resultados: La media de seguimiento fue 31 ± 18,6 meses. Un caso LESS (5%) se reconvirtió a laparoscopia. No hubo diferencias significativas entre grupos con respecto a edad, sexo, índice de masa corporal, lateralidad, localización, tamaño tumoral o empleo de doble-J; aunque hubo dominancia de ASA-I (p = 0,09) y de histología benigna (p = 0,05) en el grupo LESS. Tampoco hubo diferencias en tiempo operatorio, tiempo de isquemia, empleo de materiales hemostáticos, sangrado estimado, hemoglobina postoperatoria, transfusión u otras complicaciones. Ningún caso precisó ampliar herida cutánea para extracción de espécimen. Los pacientes LESS tuvieron menor tiempo de drenaje (p = 0,006) y menor estancia hospitalaria (p = 0,003). No hubo diferencias en número ni severidad de complicaciones según escala Clavien-Dindo. Un paciente en grupo laparoscópico falleció por TEP tras el alta hospitalaria. No hubo márgenes positivos ni recidivas o progresión de la enfermedad tumoral en el tiempo evaluado. Conclusiones: La nefrectomía parcial LESS no implica ventajas en resultados operatorios salvo menor estancia hospitalaria, posiblemente debido a hemostasia operatoria más precisa y/o selección de casos. No conlleva riesgos operatorios y oncológicos, pero tampoco supone mejora en tiempo de isquemia, pérdida hemática o tasa de transfusión. Tampoco supone una ventaja evidente en términos cosméticos

Objective: To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Material and method: Hybrid LESS technique with auxiliary 3.5mm trocar (n = 20) was compared with conventional multiport laparoscopy (n = 26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Results: Follow-up average was 31 ± 18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P = 0.09) and benign histology (P = 0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P = 0.006) and hospital stay (P = 0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Conclusions: Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes

Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis. / Eficacia de la terapia de ondas de choque de baja intensidad para la disfunción eréctil: revisión sistemática y metaanálisis.

CONTEXT: The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. OBJECTIVE: To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. ACQUISITION OF EVIDENCE: Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3-6 months from the start of the therapy. SUMMARY OF THE EVIDENCE: The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P=.000), to a greater degree than placebo (SDM, -.99; P=.000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P=.000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P=.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months. CONCLUSIONS: According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction.

Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy. / Análisis comparativo entre nefrectomía parcial LESS híbrida y laparoscópica convencional multipuerto.

OBJECTIVE: To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. MATERIAL AND METHOD: Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. RESULTS: Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. CONCLUSIONS: Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.

Cistectomía parcial laparoendoscópica umbilical / Umbilical laparoendoscopic partial cystectomy

Objetivo: Presentamos la experiencia de nuestro centro en cistectomía parcial laparoendoscópica por puerto único umbilical, tanto en proceso patológico benigno como maligno. Se revisan las características de los pacientes, los aspectos perioperatorios y la técnica quirúrgica empleada. Material y método: Desde mayo de 2012 5 pacientes fueron sometidos a cistectomía parcial laparoendoscópica por puerto único (LESS) transumbilical con material curvo a través de sistema multicanal reutilizable y un trocar accesorio de 3,5 mm. Tres fueron hombres y 2 mujeres, con edades comprendidas entre 28 y 78 (mediana 44 ± 42,5) años. La etiología fue endometriosis (2 casos), tumor en divertículo, divertículo vesical congénito y ureterocele (un caso cada uno, respectivamente). Resultados: La mediana de tiempo quirúrgico fue 273 ± 163,4 min, y el sangrado intraoperatorio 250 ± 175 ml. Ninguno de los pacientes requirió transfusión. El postoperatorio transcurrió sin incidencias, con buena evolución y sin complicación alguna. La estancia hospitalaria fue 3 ± 1 día. Con seguimiento de 20 ± 17,5 meses se ha confirmado la recuperación morfológica y funcional de vejiga y uréter en todos los casos, y el paciente con enfermedad neoplásica se encuentra libre de enfermedad más de 2 años después de la cirugía. Conclusiones: La cistectomía parcial laparoendoscópica umbilical representa una opción quirúrgica viable y segura, que consigue resultados quirúrgicos y cosméticos excelentes

Objective: To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed. Material and method: Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5 mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44 ± 42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each). Results: Median surgery time was 273 ± 163.4 minutes, and intraoperative bleeding 250 ± 175 ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3 ± 1 days. With monitoring of 20 ± 17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery. Conclusions: An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved

La cirugía retrógrada intrarrenal con litotricia láser holmium-YAG en el tratamiento primario de la litiasis renal / Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis

Introducción: La cirugía retrógrada intrarrenal (CRIR), en constante desarrollo y renovación, se presenta como una técnica eficaz y segura, y una buena alternativa terapéutica a la litotricia extracorpórea (LEOC) y la nefrolitotomía percutánea (NLP). Material y métodos: Estudio descriptivo de 50 pacientes intervenidos entre noviembre del 2012 y abril del 2013. Se recogieron datos demográficos, operatorios y postoperatorios, así como complicaciones precoces y tardías. Los pacientes fueron seguidos durante un periodo mínimo de un año. La técnica quirúrgica empleada se realizó bajo anestesia general, empleando ureteroscopio flexible, con vaina de acceso ureteral y energía de fragmentación láser. El éxito de la cirugía se definió como la ausencia de carga litiásica (stone free rate) en la prueba de control postoperatoria y a los 3 meses de la intervención (radiografía simple, ecografía o TC abdominal sin contraste). Resultados: La media ± desviación estándar de edad fue 51,1 ± 15,5 años. La localización más frecuente fue grupo calicial inferior (26%), un 58% fueron únicas y un 42%, múltiples. En un 44% la carga litiásica fue baja (< 2 cm) y en un 22% alta (> 3 cm). La media de aclaramiento litiásico en esta serie fue 89,7 ± 17,5. El tiempo quirúrgico medio fue 96,6 ± 35,2 min. Se produjeron complicaciones en 4 pacientes (8%), todas precoces y de carácter menor. Conclusiones: La CRIR es una opción eficaz y segura, comparable a LEOC y NLP, que puede considerarse de primera línea. Numerosas series corroboran estos resultados, pero se necesitan estudios prospectivos centrados en calidad de vida, estancia media, complicaciones y coste-efectividad de los diferentes tratamientos que permitan afianzar estas conclusiones

Introduction: retrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL). Material and methods: descriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast). Results: mean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (<2 cm), and high (>3 cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature. Conclusions: RIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed

Umbilical laparoendoscopic partial cystectomy.

OBJECTIVE: To present our center's experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed. MATERIAL AND METHOD: Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44±42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each). RESULTS: Median surgery time was 273±163.4minutes, and intraoperative bleeding 250±175ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3±1 days. With monitoring of 20±17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery. CONCLUSIONS: An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved.

Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis.

INTRODUCTION: retrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS: descriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast). RESULTS: mean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (<2 cm), and high (>3 cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature. CONCLUSIONS: RIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed.

Estudio comparativo entre cirugía retrógrada intrarrenal y micro-nefrolitotomía percutánea en el tratamiento de la litiasis renal de tamaño intermedio / Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones

Objetivo: La cirugía retrógrada intrarrenal (CRIR) muestra eficacia contrastada con mínima morbilidad en el tratamiento de la litiasis renal de tamaño intermedio. Se pretende estudiar la viabilidad de micro-nefrolitotomía percutánea (microperc) en esta indicación y evaluar sus resultados de forma comparativa a CRIR. Material y métodos: Desde septiembre a diciembre de 2013 realizamos un estudio comparativo prospectivo entre CRIR y microperc, en 20 pacientes consecutivos con litiasis renal de tamaño intermedio (1-3 cm). Se empleó ureteroscopio flexible de doble canal (Cobra, Richard Wolf GmbH) y Microperc 4,85/8 Fr en posición supino con fibra óptica flexible de 0,9 mm y 120º, 10.000 píxeles (PolyDiagnost GmbH). Las variables analizadas fueron: datos demográficos, características del cálculo, porcentaje de eliminación de litiasis, complicaciones (Clavien-Dindo), tiempo quirúrgico, estancia hospitalaria y necesidad de procedimientos auxiliares. Resultados: Los pacientes recibieron CRIR (n = 12) o microperc (n = 8). No existieron diferencias demográficas ni en las características de la litiasis entre ambos grupos. El porcentaje de eliminación de litiasis con CRIR fue 91,7% y con microperc 87,5% (p = 1). Un paciente tratado con CRIR (8,3%) tuvo fiebre postoperatoria y otro con microperc (12,5%) dolor cólico postoperatorio (ambos Clavien I). Los tiempos operatorios fueron similares: CRIR 120 min (111,2-148,7) y microperc 120 min (88,7-167,5) (p = 0,8). Ningún paciente necesitó transfusión sanguínea. La estancia hospitalaria fue también equivalente: CRIR 1 día (1-2) y microperc 1,5 días (1-3,5) (p = 0,33). Dos pacientes tratados con microperc (25%) necesitaron procedimientos accesorios (CRIR simultánea y nefroscopia flexible tras dilatación del trayecto percutáneo para tratar en ambos casos un fragmento significativo migrado a un cáliz no accesible) y uno en el grupo CRIR (8,3%) precisó nefrolitotomía percutánea por anatomía infundíbulo-calicial desfavorable (p = 0,54). Conclusiones: Microperc es un método mínimamente invasivo emergente, eficaz y seguro para tratar litiasis renal de tamaño intermedio. Se precisan estudios que evalúen mejor coste-efectividad, la necesidad de tratamientos complementarios y su posible complementariedad con CRIR cuando se trabaja en posición supina

Objective: Retrograde intrarenal surgery (RIRS) has proven efficacy with minimal morbidity in the treatment of intermediate-sized kidney stones. The aim of this study was to examine the feasibility of micropercutaneous nephrolithotomy (microperc) for this indication and evaluate its results compared with those of RIRS. Material and methods: From September to December 2013, we performed a comparative prospective study between RIRS and microperc, with 20 consecutive patients with intermediate-sized (1-3 cm) kidney stones. We employed a flexible dual-channel ureteroscope (Cobra, Richard Wolf GmbH) and a Microperc 4.85/8 Fr (with the patient supine) with flexible fiberoptics (0.9 mm, 120° and 10,000 pixels) (PolyDiagnost GmbH). The study variables were demographic data, stone characteristics, percentage of stone elimination, complications (Clavien-Dindo), surgical time, hospital stay and need for auxiliary procedures. Results: The patients underwent RIRS (n = 12) or microperc (n = 8). There were no differences in the demographics or stone characteristics between the 2 groups. The percentage of stone elimination with RIRS and microperc was 91.7% and 87.5% (P = 1), respectively. One of the patients who underwent RIRS (8.3%) experienced postoperative fever; one of the patients who underwent microperc (12.5%) experienced postoperative colic pain (both cases were classified as Clavien I). The operative times were similar: 120 min (111.2-148.7) and 120 (88.7-167.5) min for RIRS and microperc (P = .8), respectively. None of the patients required a blood transfusion. The hospital stays were also equivalent: 1 day (1-2) and 1.5 days (1-3.5) for RIRS and microperc (P = .33), respectively. Two patients treated with microperc (25%) required auxiliary procedures (simultaneous RIRS and flexible nephroscopy after percutaneous trajectory dilation to treat, in both cases, a significant fragment that had migrated to an inaccessible calyx), and 1 patient in the RIRS group (8.3%) required percutaneous nephrolithotomy due to unfavorable infundibular-calyceal anatomy (P = .54). Conclusions: Microperc is a minimally invasive method that is emerging as an effective and safe treatment for intermediate-sized kidney stones. Studies are needed to better evaluate its cost-effectiveness, the need for complementary treatments and its possible complementarity with RIRS when working with patients in the supine position

Tratamiento de la estenosis de uretra bulbar larga con afectación membranosa mediante uretroplastia con injerto de mucosa bucal / Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft

Introducción: Las uretroplastia con injerto de mucosa bucal es la técnica más popular en el tratamiento de la estenosis de uretra bulbar no traumática; no obstante, los casos con afectación de la porción membranosa suelen tratarse mediante uretroplastia anastomótica perineal progresiva. Se evalúa la viabilidad de llevar a cabo uretroplastia con injerto dorsal (o ventral) en estenosis de uretra bulbar y afectación principalmente membranosa con técnica de Barbagli modificada. Material y métodos: Estudio prospectivo sobre 14 pacientes con estenosis de uretra bulbomembranosa sometidos a uretroplastia de ampliación con injerto de mucosa bucal entre 2005 y 2013, según la técnica de Barbagli modificada con anclaje proximal del injerto y fijación del mismo sobre la albugínea cavernosa en 12 casos (%) y ventralmente en 2 (%). El tiempo de seguimiento mínimo fue de un año. Se evaluaron resultados subjetivos (satisfacción del paciente) y objetivos (Qmáx y RPM pre y postoperatorios) y complicaciones. Se consideró fracaso la necesidad de cualquier instrumentación postoperatoria. Resultados: Se intervinieron 14 pacientes, con una mediana de edad de 64 + 13 años. El antecedente principal detectado fue RTU de próstata en 9 casos (64,3%). La mediana de longitud de la estenosis fue 45 + 26,5 mm. Antes de la cirugía el 50% de los pacientes había sido sometido a dilataciones y el 4% a uretrotomía endoscópica. El tiempo quirúrgico fue 177 + 76 min y la estancia hospitalaria 1,5 + 1 d. Qmáx y RPM preoperatorios fueron 4,5 + 4,45 ml/seg y 212,5 + 130 cc, y postoperatorios 15,15 + 7,2 ml/seg y 6 + 21,5 cc (p < 0,01 ambas comparaciones). La cirugía resultó exitosa en 13 casos (92,9%). Ningún paciente presentó complicaciones mayores. Hubo complicaciones menores en uno (7,1%), sin precisar reintervención. Conclusión: La reparación de estenosis largas de uretra bulbar con afectación membranosa mediante uretroplastia con injerto libre de mucosa bucal supone una alternativa viable en pacientes de etiología no traumática con escasa fibrosis. La ampliación de la luz uretral consigue buenos resultados con mínima tasa de fracaso y escasa probabilidad de complicación. En muchos de estos pacientes la longitud de la estenosis es demasiado larga para realizar técnica anastomótica sin tensión

Introduction: Urethroplasty with oral mucosa grafting is the most popular technique for treating nontraumatic bulbar urethral strictures; however, cases involving the membranous portion are usually treated using progressive perineal anastomotic urethroplasty. We assessed the feasibility of performing dorsal (or ventral) graft urethroplasty on bulbar urethral strictures with mainly membranous involvement using a modified Barbagli technique. Materials and methods: This was a prospective study of 14 patients with bulbomembranous urethral strictures who underwent dilation urethroplasty with oral mucosa graft between 2005 and 2013, performed using a modified technique Barbagli, with proximal anchoring of the graft and securing of the graft to the tunica cavernosa in 12 cases (85.7%) and ventrally in 2 (14.3%). The minimum follow-up time was 1 year. We evaluated the subjective (patient satisfaction) and objective (maximum flow [Qmax] and postvoid residual volume [PVRV], preoperative and postoperative) results and complications. Failure was defined as the need for any postoperative instrumentation. Results: A total of 14 patients (median age, 64 ± 13 years) underwent surgery. The main antecedent of note was transurethral resection of the prostate in 9 cases (64.3%). The median length of the stenosis was 45 ± 26.5 mm. Prior to surgery, 50% of the patients had been subjected to dilatations and 4% to endoscopic urethrotomy. The mean surgical time and hospital stay were 177 ± 76 min and 1.5 ± 1 day, respectively. The preoperative Qmax and PVRV values were 4.5 ± 4.45 ml/s and 212.5 ± 130 cc, respectively. The postoperative values were 15.15 ± 7.2 ml/s and 6 ± 21.5 cc, respectively (p < 0.01 for both comparisons). Surgery was successful in 13 cases (92.9%). None of the patients had major complications. There were minor complications in 1 (7.1%) patient, but reintervention was not required. Conclusion: The repair of long bulbar urethral strictures with membranous involvement using urethroplasty with free oral mucosa grafts represents a viable alternative for patients with nontraumatic etiology and little fibrosis. The dilation of the urethral lumen achieves good results with minimum failure rates and little probability of complications. For many of these patients, the length of the stricture is too long to perform the tension-free anastomosis technique

Eficacia y seguridad de fosfomicina-trometamol en la profilaxis de la biopsia transrectal de la próstata: estudio prospectivo aleatorizado comparativo con ciprofloxacino / Efficacy and safety of Fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin

Objetivo: La biopsia de próstata constituye el estándar de diagnóstico del cáncer de próstata. No existe un protocolo estandarizado, pero sí recomendaciones que ayudan a disminuir la incidencia de complicaciones. El objetivo de este trabajo es evaluar la eficacia y seguridad de la profilaxis antibiótica en biopsia prostática comparando 2 dosis de fosfomicina-trometamol (FMT) 3 g (cada 48 h) con 10 de ciprofloxacino oral 500 mg (cada 12 h, 5 días). Material y métodos: Estudio prospectivo aleatorizado con 671 pacientes sometidos a biopsia prostática transrectal ecodirigida ambulante. El grupo A (n = 312) recibió ciprofloxacino y el B (n = 359) FMT. Se comparó la eficacia de ambos regímenes y tolerabilidad del tratamiento. Se practicó cultivo de orina a las 2 semanas de la biopsia. Los pacientes con bacteriuria asintomática no recibieron tratamiento antibiótico inicialmente, y se les practicó un nuevo cultivo de orina al mes, tratándose la bacteriuria persistente según el antibiograma. Resultados: No existieron diferencias entre grupos respecto a la edad (p = 0,78), presencia de cáncer (p = 0,9) o número de cilindros (p = 0,93). El número medio de cilindros obtenidos fue 11,3 + 3,25 (rango: 6-20). Nueve pacientes (2,9%) en A y 10 (2,8%) en B presentaron intolerancia digestiva. Un caso (0,3%) en A presentó reacción alérgica severa. En total 167 (24,6%) presentaron complicaciones: 16 (2,4%) fiebre, 47 (6,9%) hemospermia, 81 (11,9%) hematuria, 7 (1%) rectorragia y 16 (2,4%) retención urinaria. No se detectaron diferencias entre grupos (27,6 vs. 22,6%; p = 0,17), pero sucedió más hemospermia en A (9,9 vs. 4,5%; p = 0,006). En 44 (6,6%) se detectó bacteriuria tras la biopsia, más frecuente en B (4,2 vs. 8,6%; p = 0,02), aunque sin precisar mayor número de segundos tratamientos (53,9 vs. 29%; p = 0,17). La probabilidad de resistencia a ciprofloxacino en pacientes con bacteriuria en A fue mayor que la de FMT en B (69,2 vs. 41,9%; p = 0,0004). Conclusiones: La profilaxis antibiótica en la biopsia prostática con FMT (2 dosis de 3 g) es una opción igual de eficaz y segura que ciprofloxacino (10 dosis de 500 mg), que conlleva menor tasa de resistencias. En nuestra experiencia la profilaxis con este fármaco es una opción segura, bien tolerada y de cómoda administración, lo que facilita su cumplimiento. Se necesitan estudios multicéntricos prospectivos que confirmen estos hallazgos

Objective: Prostate biopsy is the standardized diagnostic method for prostate cancer. However, although there is not a standardized protocol, there are recommendations in order to reduce the incidence of complications. The objective of the present work is to assess the efficacy and safety of antibiotic prophylaxis in the prostate biopsy by comparing two antibiotic regimes: two doses of fosfomycin-trometamol 3 g (FMT) every 48 h with 10 doses of oral ciprofloxacin 500 mg every 12 h for 5 days. Material and methods: Randomized prospective study was performed with 671 patients who had undergone to walking transrectal ultrasound guided prostate biopsy. Patients of group A (n = 312) were treated with ciprofloxacin, and patients of group B (n = 359) with FMT. Efficacy and tolerability of two prophylactic regimes were compared. Urine culture was carried out at 2 weeks after biopsy. Initially, patients with asymptomatic bacteriuria were not treated with antibiotics; urine culture was repeated after 1 month, persistent bacteriuria was treated according to antibiogram. Results: No differences between groups were found in age (p = 0.78), cancer presence (p = 0.9) or number of biopsy cylinders (p = 0.93). The mean number of cores obtained was 11.3 ± 3.25 (range 6-20). Digestive intolerance was observed for 9 patients (2.9%) of group A and 10 patients (2.8%) in group B. One patient (0.3%) of group A showed severe allergic reaction. In total, 167 patients (24.6%) had complications: 16 (2.4%) fever, 47 (6.9%) hemospermia, 81 (11.9%) hematuria, 7 (1%) rectal bleeding and 16 (2.4%) urinary retention. No statistically differences between groups were observed (27.6% vs. 22.6%; p = 0.17). However, hemospermia was more frequent in group A (9.9% vs. 4.5%; p = 0.006). Bacteriuria after biopsy was detected in 44 patients (6.6%), being more frequent in group B patients (4.2% vs. 8.6%; p = 0.02) although a higher number of second treatment cycles were not needed (53.9% vs. 29%; p = 0.17). The likelihood of resistance to ciprofloxacin in patients with bacteriuria in A was greater than that of FMT in B (69.2% vs. 41.9%; p = 0.0004). Conclusions: Antibiotic prophylaxis with FMT (2 doses of 3 g) in prostate biopsy is an alternative as effective and safe as ciprofloxacin (10 doses of 500 mg), which carries lower rate of resistance. According to our experience, this drug is a safe, well-tolerated, and easily manageable prophylactic option, facilitating patient compliance. More prospective multicenter studies are necessary to confirm these findings

Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft.

INTRODUCTION: Urethroplasty with oral mucosa grafting is the most popular technique for treating nontraumatic bulbar urethral strictures; however, cases involving the membranous portion are usually treated using progressive perineal anastomotic urethroplasty. We assessed the feasibility of performing dorsal (or ventral) graft urethroplasty on bulbar urethral strictures with mainly membranous involvement using a modified Barbagli technique. MATERIAL AND METHODS: This was a prospective study of 14 patients with bulbomembranous urethral strictures who underwent dilation urethroplasty with oral mucosa graft between 2005 and 2013, performed using a modified technique Barbagli, with proximal anchoring of the graft and securing of the graft to the tunica cavernosa in 12 cases (85.7%) and ventrally in 2 (14.3%). The minimum follow-up time was 1 year. We evaluated the subjective (patient satisfaction) and objective (maximum flow [Qmax] and postvoid residual volume [PVRV], preoperative and postoperative) results and complications. Failure was defined as the need for any postoperative instrumentation. RESULTS: A total of 14 patients (median age, 64+13 years) underwent surgery. The main antecedent of note was transurethral resection of the prostate in 9 cases (64.3%). The median length of the stenosis was 45+26.5mm. Prior to surgery, 50% of the patients had been subjected to dilatations and 4% to endoscopic urethrotomy. The mean surgical time and hospital stay were was 177+76min and 1.5+1 day, respectively. The preoperative Qmax and PVRV values were 4.5+4.45mL/sec and 212.5+130 cc, respectively. The postoperative values were 15.15+7.2mL/sec and 6+21.5cc, respectively (P<.01 for both comparisons). Surgery was successful in 13 cases (92.9%). None of the patients had major complications. There were minor complications in 1 (7.1%) patient, but reintervention was no required. CONCLUSION: The repair of long bulbar urethral strictures with membranous involvement using urethroplasty with free oral mucosa grafts represents a viable alternative for patients with nontraumatic etiology and little fibrosis. The dilation of the urethral lumen achieves good results with minimum failure rates and little probability of complications. For many of these patients, the length of the stricture is too long to perform the tension-free anastomosis technique.

Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones.

OBJECTIVE: Retrograde intrarenal surgery (RIRS) has proven efficacy with minimal morbidity in the treatment of intermediate-sized kidney stones. The aim of this study was to examine the feasibility of micropercutaneous nephrolithotomy (microperc) for this indication and evaluate its results compared with those of RIRS. MATERIAL AND METHODS: From September to December 2013, we performed a comparative prospective study between RIRS and microperc, with 20 consecutive patients with intermediate-sized (1-3cm) kidney stones. We employed a flexible dual-channel ureteroscope (Cobra, Richard Wolf GmbH) and a Microperc 4.85/8 Fr (with the patient supine) with flexible fiberoptics (0.9mm, 120° and 10,000 pixels) (PolyDiagnost GmbH). The study variables were demographic data, stone characteristics, percentage of stone elimination, complications (Clavien-Dindo), surgical time, hospital stay and need for auxiliary procedures. RESULTS: The patients underwent RIRS (n=12) or microperc (n=8). There were no differences in the demographics or stone characteristics between the 2 groups. The percentage of stone elimination with RIRS and microperc was 91.7% and 87.5% (P=1), respectively. One of the patients who underwent RIRS (8.3%) experienced postoperative fever; one of the patients who underwent microperc (12.5%) experienced postoperative colic pain (both cases were classified as Clavien I). The operative times were similar: 120min (111.2-148.7) and 120 (88.7-167.5) min for RIRS and microperc (P=.8), respectively. None of the patients required a blood transfusion. The hospital stays were also equivalent: 1 day (1-2) and 1.5 days (1-3.5) for RIRS and microperc (P=.33), respectively. Two patients treated with microperc (25%) required auxiliary procedures (simultaneous RIRS and flexible nephroscopy after percutaneous trajectory dilation to treat, in both cases, a significant fragment that had migrated to an inaccessible calyx), and 1 patient in the RIRS group (8.3%) required percutaneous nephrolithotomy due to unfavorable infundibular-calyceal anatomy (P=.54). CONCLUSIONS: Microperc is a minimally invasive method that is emerging as an effective and safe treatment for intermediate-sized kidney stones. Studies are needed to better evaluate its cost-effectiveness, the need for complementary treatments and its possible complementarity with RIRS when working with patients in the supine position.

Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin.

OBJECTIVE: Prostate biopsy is the standardized diagnostic method for prostate cancer. However, although there is not a standardized protocol, there are recommendations in order to reduce the incidence of complications. The objective of the present work is to assess the efficacy and safety of antibiotic prophylaxis in the prostate biopsy by comparing two antibiotic regimes: two doses of fosfomycin-trometamol 3g (FMT) every 48 hours with 10 doses of oral ciprofloxacin 500 mg every 12 hours during 5 days. MATERIAL AND METHODS: Randomized prospective study was performed with 671 patients who had undergone to walking transrectal ultrasound guided prostate biopsy. Patients of group A (n=312) were treated with ciprofloxacin, and patients of group B (n=359) with FMT. Efficacy and tolerability of two prophylactic regimes were compared. Urine culture was carried out at 2 weeks after biopsy. Initially, patients with asymptomatic bacteriuria were not treated with antibiotics; urine culture was repeated after 1 month, persistent bacteriuria was treated according to antibiogram. RESULTS: No differences between groups were found in age (P=.78), cancer presence (P=.9) or number of biopsy cylinders (P=.93). The mean number of cores obtained was 11.3 ± 3.25 (range 6-20). Digestive intolerance was observed for 9 patients (2.9%) of group A and 10 patients (2.8%) in group B. One patient (.3%) of group A showed severe allergic reaction. In total, 167 patients (24.6%) had complications: 16 (2.4%) fever, 47 (6.9%) hemospermia, 81 (11.9%) hematuria, 7 (1%) rectal bleeding and 16 (2.4%) urinary retention. No statistically differences between groups were observed (27.6% vs. 22.6%; P=.17). However, hemospermia was more frequent in group A (9.9% vs. 4.5%; P=.006). Bacteriuria after biopsy was detected in 44 patients (6.6%), being more frequent in group B patients (4.2% vs. 8.6%; P=.02) although a higher number of second treatment cycles were not needed (53.9% vs. 29%; P=.17). The likelihood of resistance to ciprofloxacin in patients with bacteriuria in A was greater than that of FMT in B (69.2% vs. 41.9%; P=.0004). CONCLUSIONS: Antibiotic prophylaxis with FMT (2 doses of 3g) in prostate biopsy is an alternative as effective and safe as ciprofloxacin (10 doses of 500 mg), which carries lower rate of resistance. According to our experience, this drug is a safe, well-tolerated, and easily manageable prophylactic option, facilitating patient compliance. More prospective multicenter studies are necessary to confirm these findings.

Análisis de los factores implicados en el fracaso de la uretroplastia en el varón / Analysis of the factors involved in the failure of urethroplasty in men

Introducción: Se estudia el resultado de las técnicas de uretroplastia en nuestro entorno y los factores de riesgo de recidiva de la estenosis en estos pacientes. Material y métodos: Estudio retrospectivo sobre varones con estenosis de uretra tratada mediante uretroplastia en el periodo 2000-2012. Se obtuvieron flujo máximo (Qmáx), residuo postmiccional (RPM) y la percepción del paciente de la situación miccional, pre y postoperatoriamente. Se registraron complicaciones según la escala Clavien-Dindo. La recidiva de la estenosis (fracaso de uretroplastia) se definió mediante criterios clínicos y confirmación endoscópica o de imagen. Se llevó a cabo análisis univariante (log-rank) y multivariante (regresión de Cox) para definir las variables implicadas en la recidiva. Resultados: Fueron intervenidos 82 pacientes con edad media 55,6 ± 17,4 (19-84) años. La estenosis fue múltiple en 28%. Afectó uretra bulbar en 73,2%, peneana en 41,54% y membranosa en 14,6% de los pacientes. Se practicó anastomosis termino-terminal en 26 casos (31,7%), uretroplastia con colgajo en 21 (25,6%), con injerto libre en 31 (37,8%) y en 2 tiempos en 4 (4,9%). La uretroplastia con injerto conllevó mayor tiempo de quirófano (p = 0,02) y menor estancia hospitalaria (p = 0,0035). En cuanto a resultados, ΔQmax medio sobre basal fue 9,1 ± 7,5 e ΔRPM medio −65,8 ± 136 (ambos p < 0,0001). Se presentaron complicaciones precoces menores en 8 (9,8%) y mayores en 3 (3,6%). Sucedió recidiva en 18 pacientes (21,9%), a un tiempo medio de 39,8 ± 39,2 meses. El porcentaje de pacientes libre de recidiva fue 91,4% al año, 82,1% a 5 años y 78,1% a 10 años. El análisis univariante analizó técnica empleada (log-rank; p = 0,13), edad (p = 0,2), longitud de la estenosis (p = 0,003), Sachse previo (p = 0,18), liquen asociado (p = 0,18), multiplicidad (p = 0,36), año de cirugía (p = 0,2), Qmáx (p = 0,3) y RPM (p = 0,07) preoperatorio. El análisis de regresión identificó anastomosis termino-terminal (HR 4,98; p = 0,04) y longitud > 3 cm (HR 4,6; p = 0,01) como variables independientes asociadas a peor pronóstico. Conclusión: La longitud de la estenosis es tanto un factor pronóstico como un criterio empleado para decidir el tipo de uretroplastia, lo que supone un elemento de confusión a la hora de comparar el éxito de cada técnica. Independientemente del tamaño de la estenosis, la uretroplastia anastomótica tiene peores resultados que la uretroplastia con injerto libre de mucosa oral

Introduction: Outcome of urethroplasty techniques in our environment and risk factors for recurrence of stenosis in these patients are studied in this paper. Materials and methods: Retrospective study on men with urethral strictures treated with urethroplasty in the period 2000-2012. Maximum flow (Qmax), post-void residual (PVR) urine and patient perception of voiding were obtained pre- and postoperatively. Complications were recorded according to the Clavien-Dindo scale. Recurrent stricture was defined according to clinical criteria and endoscopic or imaging confirmation (failure of urethroplasty). Univariate analysis (log-rank) and multivariate (Cox regression) analysis were performed to define the variables implied in the recurrence. Results: 82 patients with mean age 55.6 ± 17.4 (19-84 years) underwent surgery for urethroplasty. 28% of patients showed multiple stricture, 73.2% bulbar stricture, 41.54% penile stricture and 14.6% membranous stricture. End-to-end anastomosis was performed in 26 cases (31.7%), flap urethroplasty in 21 (25.6%), urethroplasty with free graft in 31 (37.8%) and two-time urethroplasty in 4 (4.9%). Graft urethroplasty showed a longer operative time (p = 0.02) and shorter hospital stay (P = 0.0035). The results were: mean ΔQmax (mean on baseline) 9.1 ± 7.5 and mean ΔPVR −65.8 ± 136 (both P < 0.0001). Minor early complications occurred in 8 (9.8%) and major in 3 (3.6%). Recurrence occurred at a mean time of 39.8 ± 39.2 months in 18 patients (21.9%). The percentage of recurrence-free patients was: 91.4% (1-year), 82.1% (5-year) and 78.1% (10-year). Univariate analysis assessed technique used (log-rank, P = 0.13), age (P = 0.2), length stricture (P = 0.003), previous Sachse (P = 0.18), associated lichen (P = 0.18), multiplicity (P = 0.36), year of surgery (P = 0.2), Qmax (P = 0.3) and RPM (P = 0.07) preoperative. End to end anastomosis (HR 4.98, P = 0.04) and length >3 cm (HR 4.6, P = 0.01) were identified by regression analysis as independent variables associated with poor prognosis. Conclusion: Length stricture is both prognostic factor and criterion on choosing the type of urethroplasty, and it makes more complicated to compare the success rates of each surgical procedure. Whatever the stricture size is, the results of anastomotic urethroplasty are worse than those of urethroplasty with buccal mucosal-free grafts

Analysis of the factors involved in the failure of urethroplasty in men.

INTRODUCTION: Outcome of urethroplasty techniques in our environment and risk factors for recurrence of stenosis in these patients are studied in this paper. MATERIAL AND METHODS: Retrospective study on men with urethral strictures treated with urethroplasty in the period 2000-2012. Maximum flow (Qmax), post-void residual (PVR) urine and patient perception of voiding were obtained pre- and postoperatively. Complications were recorded according to the Clavien-Dindo scale. Recurrent stricture was defined according to clinical criteria and endoscopic or imaging confirmation (failure of urethroplasty). Univariate analysis (log-rank) and multivariate (Cox regression) were performed to define the variables implied in the recurrence. RESULTS: 82 patients with mean age 55.6 ± 17.4 (19-84 years) underwent surgery for urethroplasty. 28% of patients showed multiple stricture, 73.2% bulbar stricture, 41.54% penile stricture and 14.6% membranous stricture. End-to-end anastomosis was performed in 26 cases (31.7%), flap urethroplasty in 21 (25.6%), urethroplasty with free graft in 31 (37.8%) and two-time urethroplasty in 4 (4.9%). Graft urethroplasty showed a longer operative time (p = 0.02) and shorter hospital stay (P = 0.0035). The results were: mean ΔQmax (mean on baseline) 9.1 ± 7.5 and mean ΔPVR -65.8 ± 136 (both P < 0.0001). Minor early complications occurred in 8 (9.8%) and major in 3 (3.6%). Recurrence occurred at a mean time of 39.8 ± 39.2 months in 18 patients (21.9%). The percentage of recurrence-free patients was: 91.4% (1-year), 82.1% (5-year) and 78.1% (10-year). Univariate analysis assessed technique used (log-rank, P = 0.13), age (P = 0.2), length stricture (P = 0.003), previous Sachse (P = 0.18), associated lichen (P = 0.18), multiplicity (P = 0.36), year of surgery (P = 0.2), Qmax (P = 0.3) and RPM (P = 0.07) preoperative. End to end anastomosis (HR 4.98, P = 0.04) and length > 3 cm (HR 4.6, P = 0.01) were identified by regression analysis as independent variables associated with poor prognosis. CONCLUSION: Length stricture is both prognostic factor and criterion on choosing the type of urethroplasty, and it makes more complicated to compare the success rates of each surgical procedure. Whatever the stricture size is, the results of anastomotic urethroplasty are worse than those of urethroplasty with buccal mucosal-free grafts.

SU-E-T-264: New Concrete Designed and Evaluation for Megavoltage X Radiotherapy Facilities (CONTEK-RFH2).

PURPOSE: The most common material for shielding is concrete, which can be made using various materials of different densities as aggregates. New techniques in radiotherapy, as IMRT and VMAT, require more monitor units and it is important to develop specifically designed shielding materials. METHODS: Arraela S.L. has developed new concrete (CONTEK®-RFH2), which is made from an arid with a high percentage in iron (> 60%), and using the suitable sieve size, enables optimum compaction of the material and a high mass density, about 4.1-4.2 g/cm3 . Moreover, aluminate cement, used as base, gives high resistance to high temperatures what makes this product be structurally resistant to temperatures up to 1200 ° C. The measurements were made in a LINAC Elekta SL18 to energies 6MV and 15 MV with a field size of 10×10 cm2 for concrete samples in the form of tile 25cm×25cm with variable thickness. RESULTS: The linear attenuation coefficient, µm, was determined for each energy by fitting the data to Eq. 1, where Xxm is the exposure in air behind a thickness xm of the material, and X0 is the exposure in the absence of shielding. These results are compared with the ordinary concrete (2.35 g cm-3) for 6MV and 15MV energies (Ref. NCRP Report No.151). Results are tabulated in Table1. Results of attenuation are compared with ordinary concrete in Fig. 1. CONCLUSIONS: The new concrete CONTEK®-RFH2 increases photon attenuation and reduces the size of a shielded wall. A very high percentage in iron and a suitablesieve size approximately double the density of ordinary concrete. High mass attenuation coefficient makes this concrete an extremely desirable material for use in radiation facilities as shielding material for photon beam, and for upgrading facilities designed for less energy or less workload.