Laparoscopic donor nephrectomy versus open donor nephrectomy: Outcomes from a single transplant center. / Nefrectomía laparoscópica del donante vivo en comparación con nefrectomía abierta del donante vivo.

OBJECTIVES: Laparoscopic donor nephrectomy (LDN) is currently replacing open donor nephrectomy (ODN) across the world. Its advantages in terms of patient recovery are well known. We sought to compare surgical outcomes, particularly renal function during the post-nephrectomy period, for renal grafts procured by LDN versus ODN in our center. METHODS: We retrospectively analyzed all cases of living donor nephrectomies performed from 2004 to 2014 at Hospital Universitario La Paz. We compared demographic data; medical background, operative times, post-operative complications, and renal function follow up at 6, 12 and 18-month controls. RESULTS: A total of 114 living donor nephrectomies were performed: 85 LDN and 29 ODN. Demographic characteristics and medical background were similar among both groups, except mean donor age; 41.4 vs 47.4 years (p = 0.009) in the LDN and ODN groups respectively. LDN was used predominantly for left kidneys (83 out of 85), and ODN for right kidneys (28 out of 29). Although not significantly, mean operative time was shorter for the LDN group (169.37 vs 181.46 minutes; p = 0.2). Mean warm ischemia time was shorter for the ODN group (2.92 vs 2.36 minutes; p = 0.28). Differences between post-operative complications were not statistically different between both groups (p = 0.19). There were no conversions from LDN to ODN, and no re-admissions were registered. Length of stay was slightly shorter in LDN but not different (4.29 vs 4.92 days; p = 0.43). Renal function follow-up, measured with serum creatinine levels showed no difference over time (p = 0.67). CONCLUSIONS: Data from our series demonstrate that outcomes and renal function follow up over time were similar among both groups. In expert hands, this altruistic procedure can be performed with a minimally invasive approach without an increased complication rate or compromising renal function in donors.

OBJETIVOS: La nefrectomía laparoscópica del donante vivo (NLDV) está reemplazando actualmente a la nefrectomía abierta (NADV) en todo el mundo. Sus ventajas en términos de recuperación del paciente son bien conocidas. Comparamos los resultados quirúrgicos, particularmente función renal durante el periodo postnefrectomía, para los injertos obtenidos en nuestro centro por NLDV o NADV. MÉTODOS: Analizamos retrospectivamente todos los casos de nefrectomía del donante vivo realizados entre 2004 y 2014 en el Hospital Universitario La Paz. Comparamos los datos demográficos, antecedentes médicos, tiempo operatorio, complicaciones postoperatorias y funcion renal a los 6, 12 y 18 meses de seguimiento. RESULTADOS: Se han realizado un total de 114 nefrectomías del donante vivo: 85 NLDV y 29 NADV. Las características demográficas y antecedentes médicos eran similares entre ambos grupos, excepto la edad media del donante: 41,4 vs 47,4 años (p = 0,009) en los grupos de NLDV y NADV, respectivamente. La NLDV se utilizó preferentemente para riñones izquierdos (83 de 85) y la NADV para los riñones derechos (28 de 29). Aunque no fue significativo, el tiempo medio de operación del grupo de NLDV fue menor que el de NADV (169,37 vs 181,46 minutos; p = 0,2). El tiempo medio de isquemia caliente era menor en el grupo de NADV (2,92 vs 2,36 minutos; p = 0,28). No hubo diferencias estadísticamente significativas en las complicaciones postoperatorias entre ambos grupos (p=0,19). No hubo conversión a cirugía abierta en ninguna NLDV y no se registró ningún reingreso. La estancia hospitalaria fue ligeramente menor en la NLDV pero la diferencia no fue estadísticamente significativa (4,29 vs 4,92 días; p = 0,43). La función renal en el seguimiento, medida con los niveles de creatinina sérica no mostró diferencias con el tiempo (p = 0,67). CONCLUSIONES: Los datos de nuestra serie demuestran que los resultados y función renal en el seguimiento eran similares entre ambos grupos. En manos expertas, este procedimiento altruista puede ser realizado con un abordaje mínimamente invasivo sin aumento de la tasa de complicaciones o compromiso de la función renal del donante.

Cognitive Function in Patients With Prostate Cancer Receiving Luteinizing Hormone-Releasing Hormone Analogues: A Prospective, Observational, Multicenter Study.

PURPOSE: The effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in prostate cancer (PCa) patients is not well understood. We evaluated changes in CP after 6 months of medical castration with luteinizing hormone-releasing hormone (LHRH) analogues. METHODS AND MATERIALS: We performed a prospective, observational, multicenter, open-label study of PCa patients scheduled to receive LHRH analogues for ≥6 months. We assessed 4 domains of CP at baseline and after 6 months of ADT: (1) working memory, assessed with the Wechsler Adult Intelligence Scale III (WAIS III) Digit Span subtest; (2) visual memory, assessed with an ad hoc visual memory test; (3) visuospatial ability, assessed with the Judgment of Line Orientation test and Mental Rotation of Three-Dimensional Objects test; and (4) nonverbal analytical reasoning, assessed with the WAIS III Matrix Reasoning test. Changes outside the baseline 95% confidence intervals were considered significant. RESULTS: A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test whereas 63 (20.4%) experienced significant changes on ≥1 test. Most of these patients showed a change on only 1 test, distributed evenly between improvement (58 patients, 18.8%) and worsening (56 patients, 18.2%). For individual tests, most patients (87.8%-91.8%) had no change from baseline; however, the significant changes (improvement vs deterioration) were as follows: WAIS III Digit Span subtest (6.3% vs 5.9%), visual memory (5.3% vs 5.7%), Judgment of Line Orientation test (5.3% vs 4.5%), Mental Rotation of Three-Dimensional Objects test (4.1% vs 4.1%), and WAIS III Matrix Reasoning test (4.8% vs 5.8%). CONCLUSIONS: CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration.

Human native Cav1 channels in chromaffin cells: contribution to exocytosis and firing of spontaneous action potentials.

The present study was performed to evaluate the Cav1 channel subtypes expressed in human chromaffin cells and the role that these channels play in exocytosis and cell excitability. Here we show that human chromaffin cells obtained from organ donors express Cav1.2 and Cav1.3 subtypes using molecular and pharmacological techniques. Immunocytochemical data demonstrated the presence of Cav1.2 and Cav1.3 subtypes, but not Cav1.1 or Cav1.4. Electrophysiological experiments were conducted to investigate the contribution of Cav1 channels to the exocytotic process and cell excitability. Cav1 channels contribute to the exocytosis of secretory vesicles, evidenced by the block of 3µM nifedipine (36.5±2%) of membrane capacitance increment elicited by 200ms depolarizing pulses. These channels show a minor contribution to the initiation of spontaneous action potential firing, as shown by the 2.5 pA of current at the threshold potential (-34mV), which elicits 10.4mV of potential increment. In addition, we found that only 8% of human chromaffin cells exhibit spontaneous action potentials. These data offer novel information regarding human chromaffin cells and the role of human native Cav1 channels in exocytosis and cell excitability.

Perinatal and childhood factors and risk of prostate cancer in adulthood: MCC-Spain case-control study.

BACKGROUND: In utero and early-life exposures are suspected to modulate the risk of prostate cancer. This study examines the influence of certain perinatal and childhood-related factors on prostate cancer risk overall and by Gleason score at biopsy. METHODS: MCC-Spain is a multicase-control study where 1088 histologically-confirmed incident prostate cancer cases (aged 42-85years) and 1345 population-based controls (aged 38-85years), frequency matched by age and province of recruitment, were recruited in 7 Spanish provinces. Self-reported perinatal and childhood-related characteristics were directly surveyed by trained staff. The association with prostate cancer risk, globally and according to Gleason score at biopsy, was evaluated using logistic and multinomial regression mixed models, adjusting for age, family history of prostate cancer, educational level and body mass index one year before the interview, and including the province as a random effect term. RESULTS: Most perinatal factors were not related to prostate cancer risk, with the exception of middle-high socioeconomic level at birth (OR for high grade tumors=1.36; 95%CI=1.09-1.68). Regarding puberty, risk rose by 6% for each year of delayed onset (OR=1.06; 95%CI=1.01-1.10; p trend=0.016), with a clear excess of risk in men who reached puberty after age 15 (OR:1.35; 95%CI=1.08-1.68). A borderline significant positive association with prepubertal height was also observed (p trend=0.094). CONCLUSION: Some exposures experienced in utero and during adolescence, when the prostate is still maturing, might be relevant for prostate cancer risk in adulthood.

The metabolic syndrome and its components in patients with prostate cancer on androgen deprivation therapy.

PURPOSE: Androgen deprivation therapy may promote the development of the metabolic syndrome in patients with prostate cancer. We assessed the prevalence of the full metabolic syndrome and its components during the first year of androgen deprivation therapy. MATERIALS AND METHODS: This observational, multicenter, prospective study included 539 patients with prostate cancer scheduled to receive 3-month depot luteinizing hormone-releasing hormone analogs for more than 12 months. Waist circumference, body mass index, lipid profile, blood pressure and fasting glucose were evaluated at baseline and after 6 and 12 months. The metabolic syndrome was assessed according to NCEP ATP III criteria (2001) and 4 other definitions (WHO 1998, AACE 2003, AHA/NHLBI 2005 and IDF 2005). RESULTS: At 6 and 12 months after the initiation of androgen deprivation therapy, significant increases were observed in waist circumference, body mass index, fasting glucose, triglycerides, total cholesterol, and high-density and low-density lipoprotein cholesterol. No significant changes in blood pressure 130/85 or greater were detected. A nonsignificant increase of 3.9% in the prevalence of the full metabolic syndrome (ATP III) was observed (22.9% at baseline vs 25.5% and 26.8% at 6 and 12 months, respectively). The prevalence of the metabolic syndrome at baseline varied according to the definition used, ranging from 9.4% (WHO) to 50% (IDF). At 12 months significant increases in prevalence were observed with the WHO (4.1%) and AHA/NHLBI (8.1%) definitions. CONCLUSIONS: Androgen deprivation therapy produces significant early effects on waist circumference, body mass index, fasting glucose, triglycerides and cholesterol. The prevalence of and increase in the metabolic syndrome depend on the defining criteria. Counseling patients on the prevention, early detection and treatment of specific metabolic alterations is recommended.

Pharmacological characterization of native α7 nicotinic ACh receptors and their contribution to depolarization-elicited exocytosis in human chromaffin cells.

BACKGROUND AND PURPOSE: Expression of α7 nicotinic acetylcholine receptors (nAChRs) and their role in exocytosis have not yet been examined in human chromaffin cells. EXPERIMENTAL APPROACH: To characterize these receptors and investigate their function, patch-clamp experiments were performed in human chromaffin cells from organ donors. KEY RESULTS: The nicotinic current provoked by 300µM ACh in voltage-clamped cells was blocked by the nicotinic receptor antagonists α-bungarotoxin (α-Bgtx; 1µM; 6 ± 1.7%) or methyllycaconitine (MLA; 10nM; 7 ± 1.6%), respectively, in an irreversible and reversible manner, without affecting exocytosis. Choline (10mM) pulses induced a biphasic current with an initial quickly activated (5.5 ± 0.4ms rise time) and inactivated component (8.5 ± 0.4ms time constant) (termed α7), which was blocked by α-Bgtx or MLA, followed by a slower component (non-α7). α7 nAChR currents were dissected by blocking the non-α7 nAChR current component of the ACh and choline response with the α6* nAChR blocker α-conotoxin (α-Ctx) MII[S4A, E11A, L15A]. PNU-282987, an α7 nAChR-specific agonist, elicited rapidly activated and rapidly inactivated currents. α7 nAChR-positive allosteric modulators, such as 5-hydroxyindole (1mM) and PNU-120596 (10µM), potentiated responses that were blocked by α-Bgtx or MLA. Exocytosis was evoked by depolarization-elicited α7 nAChR currents, using choline in the presence of α-Ctx MII[MS4A, E11A, L15A] or PNU-282987 as agonists. CONCLUSIONS AND IMPLICATIONS: Our electrophysiological recordings of pure α7 nAChR currents elicited by rapid application of agonists demonstrated that functional α7 nAChRs are expressed and contribute to depolarization-elicited exocytosis in human chromaffin cells.

Percutaneous ureteral catheterization in laparoscopic surgery: value of nephroscopy needle trocar.

OBJECTIVES: To report our experience with use of the nephroscopy needle trocar for percutaneous catheterization. In multiple urologic procedures, surgeons use ureteral catheters to decrease morbidity, increase the success rate, and allow for postoperative radiographic follow-up. The advent of laparoscopic surgery has logically required catheterization to be adapted to our laparoscopic procedures. METHODS: The expansion of our daily practice to include multiple laparoscopic procedures showed us the difficulties inherent to ureteral catheterization in laparoscopic surgery. During our experience of >1000 laparoscopic procedures, we have used more or less complex catheterization techniques. After developing the use of the nephroscopy needle trocar for laparoscopic urinary diversion and finding that such use simplified the procedure, this technique was extended to all other laparoscopic procedures in which catheterization is required. RESULTS: We analyzed the use of the nephroscopy needle trocar in 15 ureteropyeloplasty, 21 ileal conduit, and 4 laparoscopic ureteral reimplantation procedures. The mean operating time required for anterograde catheterization in ureteropelvic junction stenosis was 3 minutes, 35 seconds, and the mean operating time for retrograde catheterization was 2 minutes, 20 seconds. Anterograde catheterization was impossible in 1 case. No cases of a false ureteral tract occurred. CONCLUSIONS: The results of our analysis have shown that the use of the nephroscopy needle trocar for percutaneous catheterization in laparoscopic surgery markedly simplifies the procedure, with the resultant savings in operating time.

Modificación en la tasa de cesáreas y sus indicaciones entre 2000 y 2006 en el Hospital de León / Changes in the rate of cesarean section and its indications between 2000 and 2006 in Leon Hospital (Spain)

Objetivo: Determinar cómo ha cambiado elporcentaje de cesáreas entre los años 2000 y 2006en el Hospital de León y analizar sus indicaciones.Material y métodos: Estudio observacional,descriptivo y retrospectivo. Analizamos 858cesáreas, 62 partos vaginales con cesárea anterior y13 en presentación podálica. Incluimos lasvariables: tipo de parto, indicación, fecha,antecedente de cesárea, presentación podálica,edad materna y gestacional y sexo del neonato.Resultados: La tasa de cesáreas subió del 19,82%al 22,06%. Las indicaciones por cesárea anterior ypodálica pasaron del 15,7 y el 15,4% al 24,8 y el20,2% respectivamente. Los partos vaginales entremujeres con antecedente de cesárea y presentaciónpodálica bajaron del 42,62 y el 15,71% al 12,6 y el2,04%, respectivamente. El número de gestantes de35 años o más en el momento de la cesáreaaumentó del 25,1 al 36,8%.Conclusiones: Aumentó la tasa de cesáreas y cambió el porcentaje en sus indicaciones: se incrementó por cesárea anterior y podálica, y disminuyó por distocia

Objective: To determine changes in the percentageof cesarean sections between 2000 and 2006 inLeon Hospital and to analyze the indications forthis procedure.Material and methods: We performed anobservational, descriptive, retrospective study. Atotal of 858 cesarean sections, 62 vaginal deliveriesafter a prior cesarean section, and 13 breechpresentation deliveries between 2000 and 2006were evaluated. The variables analyzed were typeof delivery, indication, date, prior cesarean section,breech presentation, maternal and gestational age,and sex of the newborn.Results: The cesarean section rate rose from19.82% to 22.06%. Indications for prior cesareansection and breech presentation increased from15.7% and 15.4% to 24.8% and 20.2%, respectively.Vaginal births in women with prior cesareansection and breech presentation decreased from42.62% and 15.71% to 12.6% and 2.04%,respectively. Pregnant women older than 35 yearsat cesarean section increased from 25.1% to 36.8%.Conclusions: The cesarean section rateincreased from 2000 to 2006. The percentageof cesarean sections indicated for prior cesareansection and breech presentation increased andwhile that of procedures indicated for dystociadecreased

Tumor de células de Sertoli-Leydig ovárico / Sertoli-Leydig cell ovarian tumor

Se presenta el infrecuente caso de una mujer de 62 años con un tumor ovárico asociado a hirsutismo severo, hipertensión, insuficiencia renal e hiperparatiroidismo. Se observó elevación de los valores plasmáticos de testosterona y estradiol y supresión de los de gonadotropinas. La ecografía y la tomografía computarizada revelaron un gran tumor pélvico. Se planteó el diagnóstico diferencial con los carcinomas endometrioides sertoliformes, pero la expresión positiva de la inhibina apoyó el diagnóstico de tumor de células de Sertoli-Leydig. La evolución posquirúrgica fue favorable, con normalización de los valores de los esteroides sexuales y elevación de los de gonadotropinas al valor posmenopáusico normal

We present the rare case of a 62-year-old woman who developed an ovarian tumor associated with severe hirsutism, hypertension, renal insufficiency, and hyperparathyroidism. Hormone evaluation showed high plasma testosterone and estradiol values, with suppressed gonadotropins. Ultrasound examination and computed tomography revealed a large pelvic tumor. Differential diagnosis with a Sertoli-like endometrioid carcinoma of the ovary was contemplated, but inhibin-positive expression established the diagnosis of Sertoli-Leydig cell tumor. Postsurgical outcome was favorable, with normal plasma values of sexual steroids and an increase of gonadotropins to within the normal postmenopausal range

[Laparoscopic radical prostatectomy versus robotic]. / Prostatectomía radical laparoscópica versus robótica.

OBJECTIVES: laparoscopic surgery has demonstrated that it is a good alternative to conventional surgery for the treatment of localized prostate cancer. Robotic surgery could be a therapeutic option. We try to evaluate both techniques, analyzing a series of parameters that allow us to describe the advantages and disadvantages of both techniques. METHODS: We performed a MEDLINE search and reviewed the main series of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP). The parameters analyzed for each techniques were: oncological results, functional results, blood loss, transfusion rates, surgical times, complications rates, learning curve and cost. RESULTS: Both techniques have the advantage of being minimally invasive, which results in better recovery and aesthetic results. The learning curve of the robotic prostatectomy is shorter, 10 to 20 cases in comparison with 50 to 60 for the LRP. Cost analysis is more favourable for LRP, with a single-use instrument expenditure of 533 dollars per patient in comparison with 1.705 dollars with the robot. The cost of the robot is 1.200.000 dollars plus 100.000 dollars of annual maintenance (1). Operative time was 182 minutes [ 14 1-250] for robotic surgery and 234 min. [151-453] for LRP. Within the same institution, like Montsouris, times are very similar: 155 min. for the RRP and 18 1 min. for the (LRP). Mean operative blood loss was 234 ml [75-500] for the robot and 482 ml [185-859] for the LRP depending on the technique employed and the institution. Complication rate is similar for both techniques. The percentage of positive surgical margins is 20.6% for LRP and 19.24% for RRP Long term results on the biochemical PSA recurrence cannot be given due to the short life of both techniques. Continence rates are 56-100% for LRP and 70-98% for RRP Potency rates are 25-82% for LRP and 79-100% for RRP It is difficult to evaluate hospital stay because it depends on the politics of the medical institutions; nevertheless, it seems there are not significant differences between techniques. CONCLUSIONS: Introoperative and postoperative advantages are comparable with both techniques. Robotic prostatectomy has a shorter learning curve. Prospective studies with longer follow-up are necessary to compare oncological and functional results. The cost of LRP is lower than RRP.

Tirotoxicosis en una gestación inducida por yodoprofilaxis / Thyrotoxicosis in pregnancy induced by iodine-prophylaxis

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Prostatectomía radical laparoscópica versus robótica / Laparoscopic radical prostatectomy versus robotic

Objetivo: La cirugía laparoscópica ha demostrado ser una buena alternativa a la cirugía abierta para el tratamiento del cáncer de próstata localizado. La cirugía robótica podría ser una opción terapéutica. Pretendemos hacer una evaluación de ambas técnicas, analizando una serie de parámetros que nos permitan describir las ventajas e inconvenientes de ambas técnicas. Métodos: Hemos realizado una búsqueda en MED-LINE, revisando las mayores series de Prostatectomía Radical Laparoscópica (PRL) y Prostatectomía Radical Robótica (PRR)y hemos analizado los siguientes parámetros de cada técnica: resultados oncológicos, resultados funcionales, pérdida sanguínea, tasa de transfusión, tiempo quirúrgico, tasa de complicaciones, curva de aprendizaje y coste. Resultados: Ambas técnicas tienen la ventaja de ser mínimamente invasivas, con ventajas en la recuperación del paciente y en los resultados estéticos. La curva de aprendizaje es menor para la prostatectomía robótica, siendo de 10 a 20 casos para ésta y de 50 a 60 casos para la PRL. El análisis de los costes económicos es más favorable para la PRL que tiene un gasto en fungibles por paciente de 533 dólares, siendo éste de 1.705 dólares para la robótica. El precio del robot es de 1.200.000 dólares más un gasto anual de mantenimiento de 100.000 dólares. El tiempo operatorio es de 182 min. [141-250] para la robótica y de 234 min. [151-453] para la PRL. Dentro de una misma institución, como ocurre en Montsouris, los tiempos son muy parecidos tardando 155 min. para la robótica y 181 min. para la PRL (tabla 3). El sangrado medio operatorio es de 234 ml. [75-500] para la robótica y de 482 ml. [185-859] para la PRL, dependiendo de la técnica utilizada y de las distintas instituciones. El porcentaje de complicaciones es similar con ambas técnicas. El porcentaje de márgenes quirúrgicos positivos es de 20.6% para la PRL y del 19.24% para la robótica. No se pueden dar todavía resultados a largo plazo sobre recurrencia bioquímica del PSA debido a la corta existencia de ambas técnicas. La tasa de continencia para la PRL es de 56-100% y para la robótica del 70-98%. La tasa de potencia para la PRL es del 25-82% y para la robótica del 79-100%. No existen datos lo suficientemente claros para decir que existan diferencias significativas en cuanto a resultados funcionales. Es difícil evaluar la estancia postoperatoria ya que muchas veces depende de la política de la instituciones médicas, aunque en conjunto no parece que existan diferencias significativas entre ambas técnicas. Conclusiones: La ventajas intraoperatorias y postoperatorias son comparables con las dos técnicas. La prostatectomía robótica tiene una curva de aprendizaje más corta. Son necesarios estudios prospectivos con mayor seguimiento para poder comparar los resultados oncológicos y funcionales. El coste de la PRL es menor que el de la robótica (AU)

Objectives: Laparoscopic surgery has demonstrated that it is a good alternative to conventional surgery for the treatment of localized prostate cancer. Robotic surgery could be a therapeutic option. We try to evaluate both techniques, analyzing a series of parameters that allow us to describe the advantages and disadvantages of both techniques. Methods: We performed a MEDLINE search and reviewed the main series of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP). The parameters analyzed for each techniques were: oncological results, functional results, blood loss, transfusion rates, surgical times, complications rates, learning curve and cost. Results: Both techniques have the advantage of being minimally invasive, which results in better recovery and aesthetic results. The learning curve of the robotic prostatectomy is shorter, 10 to 20 cases in comparison with 50 to 60 for the LRP. Cost analysis is more favourable for LRP, with a single-use instrument expenditure of 533 dollars per patient in comparison with 1.705 dollars with the robot. The cost of the robot is 1.200.000 dollars plus 100.000 dollars of annual maintenance. Operative time was 182 minutes [141-250] for robotic surgery and 234 min. [151-453] for LRP. Within the same institution, like Montsouris, times are very similar: 155 min. for the RRP and 181 min. for the (LRP). Mean operative blood loss was 234 ml [75-500] for the robot and 482 ml [185-859] for the LRP, depending on the technique employed and the institution. Complication rate is similar for both techniques. The percentage of positive surgical margins is 20.6% for LRP and 19.24% for RRP. Long term results on the biochemical PSA recurrence cannot be given due to the short life of both techniques. Continence rates are 56-100% for LRP and 70-98% for RRP. Potency rates are 25-82% for LRP and 79-100% for RRP. It is difficult to evaluate hospital stay because it depends on the politics of the medical institutions; nevertheless, it seems there are not significant differences between techniques. Conclusions: Intraoperative and postoperative advantages are comparable with both techniques. Robotic prostatectomy has a shorter learning curve. Prospective studies with longer follow-up are necessary to compare oncological and functional results. The cost of LRP is lower than RRP (AU)

Satisfacción del paciente urológico en consultas externas / Satisfaction of patients attending urology outpatient clinics

Objetivo: Valorar la satisfacción de los pacientes de consultas externas del servicio de urología del Hospital La Paz e identificar posibles problemas en la atención. Material y método: Estudio transversal utilizando un cuestionario de satisfacción que se entregó a los pacientes que acudieron a los centros de consultas externas de urología durante una semana del mes de noviembre de 2002. Resultados: La encuesta fue contestada por un total de 532 pacientes. La mitad de los pacientes pertenecen al grupo de mayores de 65 años. El 72,2 por ciento conoce el nombre del urólogo que les atiende, mientras que sólo el 27,4 por ciento conoce el de la/el enfermera/o. Al estratificar esta variable por centro, observamos que el número de pacientes que afirma conocer el nombre de su urólogo en consultas hospitalarias es superior (197; 86,4 por ciento) que en centros de especialidades (171; 70 por ciento). En los centros de especialidades, el 22,9 por ciento afirma que el tiempo dedicado a su consulta fue "escaso" o "muy escaso"; en las cuatro salas del hospital es del 6,7 por ciento. Encontramos diferencias significativas al comparar la satisfacción entre centros respecto a las variables información sobre riesgos del diagnóstico y tratamiento, instrucciones dadas tras el alta y descripción de los síntomas por los que el paciente debe consultar de nuevo al urólogo. La satisfacción es mayor en consultas hospitalarias. Ciento setenta y dos (32,3 por ciento) de los pacientes han realizado sugerencias. El grupo más numeroso corresponde a las relacionadas con la mejora del sistema de citaciones, la reducción de la lista de espera y el excesivo tiempo de espera previo a la consulta. La satisfacción global con el servicio presenta diferencias significativas entre pacientes que acuden a consultas hospitalarias y a centros de especialidades externos. Conclusiones: El conocimiento del nombre de los profesionales sanitarios, el tiempo dedicado a consulta y la información sobre riesgos derivados del diagnóstico y tratamiento son aspectos muy valorados por los pacientes de consultas de urología y están asociados a una mayor satisfacción global con el servicio. La espera previa a la consulta y las dificultades para la citación son las oportunidades de mejora expresadas mayoritariamente en el apartado de sugerencias. Existen diferencias en la satisfacción entre pacientes de consultas hospitalarias y consultas de centros de especialidades (AU)

Resultados e impacto de una vía clínica para trasplante renal tras un año de desarrollo / Evaluation and impact of a clinical pathway for renal transplant after a one-year experience

Fundamento: La disminución de la variabilidad inapropiada en la práctica clínica es una oportunidad de mejora de la calidad asistencial. Las vías clínicas representan una posible solución para este tipo de variabilidad. El objetivo del estudio fue evaluar el impacto de una vía clínica para trasplante renal. Métodos: A los 3 meses de implantación de la vía se realizó un análisis preliminar. Tras la puesta en marcha de medidas de mejora se prosigue con la implantación definitiva. Pasado 1 año se evalúan los resultados y el impacto. Se revisa la documentación de los pacientes atendidos mediante el análisis de la cobertura, las estancias, las variaciones, los sucesos adversos y la satisfacción. Se comparan los resultados obtenidos con los 12 meses anteriores a la implantación. Resultados: Entre noviembre de 1999 y noviembre de 2000 fueron intervenidos 32 pacientes. La cobertura de la vía fue del 97 por ciento. Las estancias hospitalaria y urológica se cumplieron por el 48,4 por ciento y el 62,1 por ciento de los pacientes. La estancia media hospitalaria fue de 18,9 días frente a 22,1 en el período anterior a la vía y representó una diferencia no significativa (p = 0,203), aunque se observa una importante disminución de la variabilidad-desviación estándar [DE]: 8,33 frente a 11,04 días). El mayor número de variaciones dependió del enfermo (68,2 por ciento). El porcentaje de sucesos adversos fue del 61,3 por ciento frente al 90,3 por ciento (p = 0,016). Se consideraron como predictores independientes de episodios adversos: la estancia ( odds ratio [OR] = 1,32, p = 0,004) y la condición pre-vía (OR = 7,42, p = 0,017). La cobertura de la encuesta de satisfacción fue del 68 por ciento. La satisfacción con la atención recibida fue del 94,5 por ciento. Conclusiones: Se han detectado oportunidades de mejora, cumplimiento de estancias o cobertura de encuesta, pero la disminución de la variabilidad en estancia, sin incremento de acontecimientos no deseados y su disminución al controlar por estancia en pacientes con vía, confirma que la vía clínica de trasplante renal es una herramienta útil para disminuir la variabilidad y mejorar la calidad científico-técnica, la calidad percibida y la eficiencia en la práctica clínica (AU)