Extracorporeal shock wave lithotripsy for distal ureteral calculi: improved efficacy using low frequency.

OBJECTIVES: To compare low versus high frequency for lithotripsy in the management of distal ureteral calculi. METHODS: A total of 154 patients with radio-opaque calculi (0.5-1 cm diameter) in the distal ureter were randomized to be given either lithotripsy at 80 or 60 pulses per min (high frequency or low frequency groups, respectively). The number of waves and sessions received, and time to total resolution were measured. A Dornier Compact Delta lithotripter was used. RESULTS: A total of 72 patients were assigned to the high frequency group and 78 to the low frequency group. Four patients were excluded from the study because of intolerance of the procedure. The size was slightly lower in low frequency group, whereby an analysis of covariance was carried out to eliminate the size factor, with the limit established as 0.7 cm. The low frequency group received 2980 ± 1211 waves, and the high frequency group received 5752 ± 3121 (P<0.001). The success rate was higher in the low frequency group (100%) than in the high frequency group (92.9%; P=0.02). If adjusted to the size of the calculus with a threshold of 0.7 cm, there was a difference, although it was not statistically significant. The time to elimination of the fragments was higher in the high frequency group (17.68 days) than in the low frequency group (7.15 days; P<0.001). The number of sessions necessary for resolution was higher in the high frequency group (1.56) than in the low frequency group (1.14; P<0.001). CONCLUSIONS: Lithotripsy at 60 pulses provides better outcomes than lithotripsy at 80 pulses for the treatment of distal ureteral calculi.

[Papillary renal carcinoma presenting as hydronephrosis]. / Hidronefrosis como cáncer papilar renal.

BACKGROUND: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review. METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis. RESULTS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter. CONCLUSIONS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter.

Hidronefrosis como cáncer papilar renal / Papillary renal carcinoma presenting as hydronephrosis

OBJETIVO: Describir un nuevo caso de carcinoma papilar incidental. Revisión de la literatura.MÉTODOS: El carcinoma papilar renal (CRP) es una variante dentro del carcinoma renal. Se clasifican en dos subtipos que tienen relación con su pronóstico. Presentamos un caso de CRP en un varón de 76 años, simulando una hidronefrosis evolucionada.RESULTADO/CONCLUSIONES: Se describen los hallazgos y el posterior resultado histológico asociado de una metástasis sincrónica en el uréter ipsilateral(AU)

OBJECTIVE: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review.METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis.RESULTS/DISCUSSION: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter(AU)

Impacto de una vía clínica para pacientes intervenidos con resección transuretral en próstata y vejiga / Impact of a clinical pathway in cases of transurethral resection of the prostate and bladder

Objetivo. Conocer, desde una triple perspectiva, clínica, económica y centrada en el paciente, la efectividad de una vía clínica. Método. Para ello, se diseñó un estudio experimental, en el que participaron 122 pacientes intervenidos de hiperplasia benigna de próstata o carcinoma vesical mediante resección transuretral (RTU), divididos en 2 grupos, experimental y control. La aleatorización se realizó sobre los listados de espera y, al ser hospitalizados, se controló que el ingreso no se produjera en la misma habitación que otro paciente incluido en distinto grupo, para mantener el simple ciego. Resultados. La comparación de ambos grupos detectó diferencias respecto a los días de estancia (desviación estándar [DE]): 3,59 (1,54) frente a 2,92 (1,18), p = 0,008. Los pacientes del grupo control, en promedio, estaban 0,67 días de más hospitalizados (intervalo de confianza [IC] del 95%, 0,18-1,17) que los del grupo al que se le aplicó la vía clínica. No se detectaron diferencias estadísticamente significativas en cuanto a presentación de complicaciones (el 3,6 frente al 1,8%; p = 0,55), ni en la satisfacción (el 90,9 frente al 94,5%; p = 0,46). Conclusiones. Las vías clínicas producen una reducción de la estancia, si bien el mecanismo por el que lo hacen efectivo no está claro

Objective. To determine the effectiveness of a clinical pathway from a triple perspective: clinical, economic, and patient-centered. Methods. We designed an experimental study. A total of 122 patients undergoing surgery for benign prostatic hyperplasia or cancer of the bladder through transurethral resection were divided into 2 groups: experimental and control. Patients on the waiting list for surgery were randomized to one of the two groups. To guarantee simple blinding, admitted patients were not assigned to the same ward as another patient in the other group. Results. Comparison of the two groups revealed differences in the length of hospital stay (SD): 3.66 (1.42) versus 2.98 (1.42), p = 0.015. On average, length of hospital stay was 0.68 days (95% CI, 0.13-1.21) longer in the control group than in patients in whom the clinical pathway was applied. No significant differences were detected in the complication rate (3.6% versus 1.8%, p = 0.55) or in patient satisfaction (94.5% versus 90.9%, P = 0.46). Conclusions. Clinical pathways reduce the length of hospital stay, although the mechanism through which this reduction is achieved is not entirely clear