[Questionnaire for urological emergency room quality evaluation]. / Cuestionario de evaluación de la calidad asistencial en un servicio de urgencias urológicas.

INTRODUCTION: Quality is defined as an essential and distinguishing attribute of something, which allows to evaluate its worth. The quality evaluation has become something necessary during the last years. The assistencial quality should be something inherent to the offered service, including scientific and technical quality, management and quality noticed. A periodical assesment, as auto-evaluation or through an outsourcing, is a recommendable way to detect potential improvement items. MATERIAL AND METHODS: Using the EFQM,ISO 9001:2000 and Malcolm Baldrige model, and through the items from National Health System, a self-questionnaire of urological emergency room quality evaluation is proposed. CONCLUSION: A new self-questionnaire of urological emergency room quality evaluation is proposed.

[Severe cystitis and perivesical collection posterior to Mitomycin C immediate instillation in a patient with inadverted bladder perforation]. / Cistitis severa y colección perivesical posterior a instilación inmediata de Mitomicina C en paciente con perforación vesical inadvertida.

We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it.

Cuestionario de evaluación de la calidad asistencial en un servicio de urgencias urológicas / Questionnaire for urological emergency room quality evaluation

Introducción: Definida calidad por la propiedad o conjunto de propiedades inherentes a algo, que permiten juzgar su valor, su evaluación se ha convertido en algo obligado en las últimas décadas. La calidad asistencial debe, por tanto, ser inherente al servicio ofrecido. Ha de incluir calidad científica, calidad técnica, gestión y calidad percibida. La evaluación periódica, bien a través de una empresa externa o como auto-evaluación, constituye una forma directa de detectar aspectos susceptibles de mejora. Material y métodos: Siguiendo los modelos Europeo de Excelencia empresarial (EFQM), la Norma ISO 9001:2000 y el modelo Malcom Baldrige, y partiendo de los indicadores clave del Sistema Nacional de Salud se crea un formulario de evaluación de la calidad global. Conclusiones: Se propone un cuestionario destinado a evaluar la calidad asistencial de un servicio de urgencias urológicas (AU)

Introduction: Quality is defined as an essential and distinguishing attribute of something, which allows to evaluate its worth. The quality evaluation has become something necessary during the last years. The assistencial quality should be something inherent to the offered service, including scientific and technical quality, management and quality noticed. A periodical assesment, as auto-evaluation or through an outsourcing, is a recommendable way to detect potential improvement items. Material and methods: Using the EFQM, ISO 9001:2000 and Malcolm Baldrige model, and through the items from National Health System, a self-questionnaire of urological emergency room quality evaluation is proposed. Conclusion: A new self-questionnaire of urological emergency room quality evaluation is proposed (AU)

Cistitis severa y colección perivesical posterior a instilación inmediata de Mitomicina C en paciente con perforación vesical inadvertida / Severe cystitis and perivesical collection posterior to mitomycin C immediate instillation in a patient with inadverted bladder perforation

Se trata de un paciente masculino de 40 años de edad quien, posterior a una RTU de recidiva de tumor no músculo invasivo sin perforación aparente e instilación inmediata de Mitomicina C, consultó al cuarto día postoperatorio a nuestro servicio de urgencias con sintomatología urinaria irritativa baja severa. Se solicitó una ecografía renovesical que evidenció una colección perivesical. El manejo fue conservador con sondaje vesical por 10 días siendo necesaria la punción-drenaje de la colección (AU)

We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it (AU)

Cierre quirúrgico de la pared abdominal. Conceptos básicos / Abdominal wall closure. Basic concepts

La técnica quirúrgica para el cierre de la pared abdominal se basa a menudo en la tradición más que en la evidencia. Un conocimiento de la función dinámica de la pared abdominal es esencial para su cierre adecuado. Es necesario que los cirujanos identifiquen y utilicen técnicas y materiales apropiados para minimizar la incidencia de fallos incisionales como la evisceración y la eventración. Los errores técnicos locales como el cierre bajo tensión (mala relajación) que estrangula la fascia y la toma inadecuada de tejido con la sutura son las causa más frecuentes de eventración (AU)

Abdominal wall closure surgical practice continues to rely largely on tradition rather tan evidence. We do need to identify appropriate technique and suture material in order to achieve a lower rate of incisional hernia. Local technical errors as high tension closure which stretches fascia and an inadequate fascia´s margin with suture are the most frequent causes of incisional hernia (AU)

[Algorithm for the treatment of patients with obstructive uropathy secondary to prostate cancer]. / Algoritmo para el manejo de pacientes con uropatía obstructiva secundaria a cáncer de próstata.

BACKGROUND: One of the prostate cancer progression complications is the obstructive uropathy, by infiltration and compression of the distal ureteral section, that can entail to an acute renal insufficiency, with affectation of the quality of life and the survival of these patients. The treatment of prostate cancer with secondary ureterohidronefrosis is palliative and following the present tendencies, the positioning of a nephrostomy is considered. MATERIALS AND METHODS: A search was made in PUBMED and the most representative articles were reviewed. The algorithm was constructed with the daily routine clinical base, the protocol of our center and with the scientific evidence available in medical literature. RESULTS: An algorithm of decisions sets out to define the urinary derivation in patients with obstructive uropathy secondary to prostate cancer. CONCLUSIONS: The indication to place a nephrostomy in patients with obstructive uropathy secondary to prostate cancer must be approached individually, according to the general conditions and the quality of life of the patient with base in scales defined in literature (ECOG and Karnofsky) and in factors of good or bad prognosis, always considering ethical considerations and the consent of the patient and his family.

Algoritmo para el manejo de pacientes con uropatía obstructiva secundaria a cáncer de próstata / Algorith for the treatment of patients with obstructive uropathy secondary to prostate cancer

Introducción: Una de las complicaciones de la progresión del cáncer de próstata es la uropatía obstructiva, por infiltración y compresión del tramo ureteral distal, que puede conllevar a una insuficiencia renal aguda, con afectación de la calidad de vida y la supervivencia de estos pacientes. El tratamiento del cáncer de próstata con ureterohidronefrosis secundaria es paliativo y siguiendo las tendencias actuales, se debe considerar la colocación de una nefrostomía. Materiales y Métodos: Se realizó una búsqueda en PUBMED y se revisaron los artículos más representativos. El algoritmo se construyó con base en la práctica clínica diaria basada en la rutina, el protocolo de nuestro centro y con la evidencia científica disponible en la literatura médica. Resultados: Se propone un algoritmo de decisiones para definir la derivación urinaria en pacientes con uropatía obstructiva secundaria a cáncer de próstata. Conclusiones: La indicación de colocar una nefrostomía en pacientes con uropatía obstructiva secundaria a cáncer de próstata debe abordarse individualmente, de acuerdo a las condiciones generales y la calidad de vida del paciente con base en escalas ya definidas en la literatura (ECOG y Karnofsky) y en factores de buen o mal pronóstico, siempre teniendo en cuenta consideraciones éticas y el consentimiento del paciente y de su familia (AU)

Background: One of the prostate cancer progression complications is the obstructive uropathy, by infiltration and compression of the distal ureteral section, that can entail to an acute renal insufficiency, with affectation of the quality of life and the survival of these patients. The treatment of prostate cancer with secondary ureterohidronefrosis is palliative and following the present tendencies, the positioning of a nephrostomy is considered. Materials and Methods: A search was made in PUBMED and the most representative articles were reviewed. The algorithm was constructed with the daily routine clinical base, the protocol of our center and with the scientific evidence available in medical literature. Results: An algorithm of decisions sets out to define the urinary derivation in patients with obstructive uropathy secondary to prostate cancer. Conclusions: The indication to place a nephrostomy in patients with obstructive uropathy secondary to prostate cancer must be approached individually, according to the general conditions and the quality of life of the patient with base in scales defined in literature (ECOG and Karnofsky) and in factors of good or bad prognosis, always considering ethical considerations and the consent of the patient and his family (AU)

Small renal masses: incidental diagnosis, clinical symptoms, and prognostic factors.

Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach. Materials and methods. Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review. Results. SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM. Conclusions. Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.

Notas del Congreso Europeo de Urología. Análisis de las últimas aportaciones sobre BCG endovesical / European Urology Congress notes. Analysis of the last investigations on endovesical BCG

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El fenómeno "pT0" en carcinoma vesical. Revisión de la literatura y de nuestra casuística / The pT0 phenomenom in the bladder carcinoma. State of the art and our casuistic

Evaluar el fenómeno pT0 en cáncer vesical en nuestra institución y realizar una revisón en la literatura. Entre agosto de 1978 y junio de 2002, 1.114 pacientes fueron sometidos a cistectomía radical en nuestra institución por carcinoma vesical infiltrante. Se realizó una revisón bibliográfica a partir de los estudios publicados en la base de datos Pubmed entre 1981 y 2006. Del total de casos, 141 (12,65%) presentaron estadío pT0. La mediana de seguimiento fue de 42,50 meses (1,03-246). Se estudiaron la supervivencia global y cáncer específica de nuevas publicaciones. A pesar de la buena evolución clínica de la mayoría de los pacientes con estadía pT0 después de cistectomía radical, no se puede considerar a estos pacientes como curados de su enfermedad con tasas de supervivencia global y cáncer específica similares a aquellos con esta´dio superficial o confinado al músculo en la pieza de cistectomía; por lo cual deben ser controlados de manera similar a pacientes con tumor en la pieza de cistectomía

To evaluate the phenomenon pT0 in vesical carcinoma at our institution and to make a literature review. Between August 1978 and June 2002, 1.114 patients were subjected to a radical cystectomy at our institution due to an infiltration vesical carcinoma. A bibliographical review was realized from the studies published in the base of Pubmed information between 1981 and 2006. Of the whole of cases, 141 (12,65%) presented a pT0 phase. The average of the monitoring was of 42.50 months (1.03-246). It was studied the global survival and specific caqrcinoma, as well as the clinical and associated pathological factors with the survival that they will be a motive of new publications. In spite of the good clinical evolution of the majoritiy of the patients with a pT0 phase after the radical cystectomy, they can´t be considered like treated of its disease with rates of global survival and specific carcinoma similar to those with superficial or confined phase in the muscle in the piece of cystectomy; for which they must be controlled of similar way to patients with a tumor in the piece of cystectomy