Urologists' and general practitioners' knowledge, beliefs and practice relevant for opportunistic prostate cancer screening: a PRISMA-compliant systematic review.

Background: Recent guidelines on opportunistic prostate cancer screening conclude that the decision to screen with prostate-specific antigen should be made by each patient individually together with the clinician. However, there is evidence of a lack of clinicians' awareness of prostate cancer screening. This study sought to assess the recent evidence of clinicians' knowledge, beliefs, and practice regarding opportunistic prostate cancer screening comparing urologists and generals practitioners. Methods: A systematic search was conducted in 3 online databases: MEDLINE, Web of Science and EMBASE (from January 1, 2015, to January 9th, 2023). Studies that explored clinicians' knowledge, beliefs, and practices regarding opportunistic prostate cancer screening were included. Studies were assessed for quality reporting according to the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Results: A total of 14 studies met the inclusion criteria: ten studies included primary care health professionals, three studies included urologists, and one study included both. Studies involving general practitioners showed a generally low level of awareness of the recommended uses of the test, and urologists showed a greater knowledge of clinical practice guidelines. General practitioners' opinion of prostate-specific antigen was generally unfavourable in contrast to urologists' who were more likely to be proactive in ordering the test. Less than half of the included studies evaluated shared-decision making in practice and 50% of clinicians surveyed implemented it. Conclusion: General practitioners had less knowledge of prostate cancer risk factors and clinical practice guidelines in the use of PSA than urologists, which makes them less likely to follow available recommendations. A need to carry out education interventions with trusted resources based on the available evidence and the current guidelines was identified.

Barriers and facilitators of shared decision-making in prostate cancer screening in primary care: A systematic review.

Objective: To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care. Design: Systematic review of articles. Data sources: PubMed, Scopus, Embase and Web of Science. Eligibility criteria: Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied. Data extraction and synthesis: Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies. Results: The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information. Conclusions: SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM.

Reply to Jue, J.S.; Alameddine, M. Role of PSA Density and MRI in PSA Interpretation. Comment on "Lumbreras et al. Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data. Cancers 2023, 15, 261".

We thank you and your co-authors for the comment [...].

PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study.

Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.

Variables Associated with False-Positive PSA Results: A Cohort Study with Real-World Data.

(1) Background: There are no real-world data evaluating the incidence of false-positive results. We analyzed the clinical and analytical factors associated with the presence of false-positive results in PSA determinations in practice. (2) Methods: A prospective cohort study of patients with a PSA test was performed in clinical practice. We followed the patients by reviewing their medical records for 2 years or until the diagnosis of PCa was reached, whichever came first. (3) Results: False-positive PSA rate was 46.8% (95% CI 44.2-49.2%) and false-negative PSA rate was 2.8% (95% CI 2-3.5%). Patients aged 61-70 years and those over 70 years were more likely to have a false-positive result than those under 45 years (aOR 2.83, 95% CI 1.06-7.55, p = 0.038, and aOR 4.62, 95% CI 1.75-12.22, p = 0.002, respectively). Patients with urinary tract infection were more likely to have a false-positive result (aOR 8.42, 95% CI 2.42-29.34, p = 0.001). Patients with diabetes mellitus were less likely to have a false-positive result (aOR 0.63, 95% CI 0.41-0.98, p = 0.038); (4) Conclusions: This study has generated relevant information that could be very useful for shared decision making in clinical practice.

Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62-69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02-1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67-0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

Comparative assessment of biodegradable-antireflux heparine coated ureteral stent: animal model study.

BACKGROUND: Double J ureteral stents are widely used on urological patients to provide drainage of the upper urinary tract. Unfourtunately, ureteral stents are not free from complications, as bacterial colonization and require a second procedure for removal. The purpose of the current comparative experimental study is to evaluate a new heparin-coated biodegradable antireflux ureteral stent (BraidStent®-H) to prevent urinary bacterial colonization. METHODS: A total of 24 female pigs were underwent determination of bacteriuria and nephrosonographic, endoscopic and contrast fluoroscopy assessment of the urinary tract. Afterward, were randomly assigned animals to Group-I, in which a 5Fr double-pigtail ureteral stent was placed for 6 weeks, or Group-II, in which a BraidStent®-H was placed. Follow-up assessments were performed at 1, 3, 6, 8, 12 weeks. The final follow-up includes the above methods and an exhaustive pathological study of the urinary tract was accomplished after 20 weeks. RESULTS: Bacteriuria findings in the first 48 h were significant between groups at 6 h and 12 h. Asymptomatic bacteriuria does not reach 100% of the animals in Group-II until 48 h versus Group-I where it appears at 6 h. The weekly bacteriuria mean rate was 27.7% and 44.4% in Group I and II respectively, without statistical significance. In Group II there were no animals with vesicoureteral reflux, with statistical significance at 3 and 6 weeks with Group-I. The 91.2% of stents in Group-II were degraded between 3 and 6 weeks, without obstructive fragments. Distal ureteral peristalsis was maintained in 66.6-75% in Group-II at 1-6 weeks. CONCLUSIONS: The heparin coating of BraidStent® allows an early decrease of bacterial colonization, but its effectiveness is low at the long term. Heparin coating did not affect scheduled degradation rate or size of stents fragments. BraidStent®-H avoids the side effects associated with current ureteral stents, thus should cause less discomfort to patients.

Tratamiento médico del cólico renoureteral en su fase aguda / Medical treatment for acute renal colic

INTRODUCCIÓN: El cólico renoureteral (CRU) es la urgencia urológica más frecuente, con un amplio espectro de gravedad que genera una alta morbilidad y elevados costes sanitarios. Sin embargo, no existe un esquema homogéneo de tratamiento farmacológico en su fase aguda. OBJETIVOS: El objetivo principal de nuestro trabajo es evaluar la efectividad y perfil de seguridad de los distintos fármacos empleados en el tratamiento del CRU y proponer un esquema práctico de tratamiento. Los objetivos secundarios son evaluar el papel de la fluidoterapia en el CRU y el tratamiento del CRU en embarazadas. MATERIAL Y MÉTODOS: Hemos realizado una búsqueda bibliográfica en PubMed utilizando los términos MeSH "renal colic", "treatment", "anti-inflammatory-drugs", "antiemetic drugs", "fluid therapy" y "pregnant". Se revisaron ensayos clínicos, metaanálisis y revisiones sistemáticas de mayor relevancia, publicados desde el 1 de enero de 2005 hasta el 15 de septiembre de 2020, escritos en lengua española, inglesa y francesa. RESULTADOS: En los diferentes estudios revisados los antiinflamatorios no esteroideos (AINES) muestran un mejor control del dolor, con menores dosis de rescate y menos efectos secundarios que el tratamiento con opioides. Sin embargo, la fluidoterapia no ha logrado demostrar una repercusión en el tratamiento del CRU. CONCLUSIONES: El tratamiento de primera elección para el CRU son los AINES, reservando los opioides para sucesivas líneas de tratamiento. El control del cortejo vegetativo se puede realizar con ondansetrón como primera elección

INTRODUCTION: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acute phase. AIMS: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renal colic", "treatment", "anti-inflammatory drugs", "antiemetic drugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed. RESULTS: In the different studies reviewed, non-steroidal anti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU. CONCLUSIONS: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice

Tratamiento médico expulsivo de la litiasis ureteral / Medical expulsive treatment for ureteral stones

INTRODUCCIÓN: El Tratamiento Médico Expulsivo (TME) para litiasis ureterales ha sido puesto en cuestión durante los últimos años. OBJETIVOS: El objetivo principal de nuestro trabajo es definir las indicaciones del TME, los fármacos empleados y su efectividad y proponer un esquema de seguimiento. Los objetivos secundarios son analizar la efectividad del TME en algunos subgrupos especiales de la población como son las embarazadas y los niños y valorar aspectos de coste-efectividad del TME en comparación con otras opciones de tratamiento de litiasis ureterales (ureterorrenoscopia o litotricia extracorpórea por ondas de choque). MATERIAL Y MÉTODOS: Hemos realizado una revisión de los ensayos clínicos y metaanálisis de mayor relevancia que valoran la efectividad de los diferentes fármacos disponibles para el TME. Para la búsqueda bibliográfica hemos utilizado algunos términos como medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" y "calcium-antagonists", siendo la principal base de datos consultada MEDLINE (a través del portal web PubMed). RESULTADOS: Aún los estudios de mayor calidad presentan importantes limitaciones metodológicas, lo que condiciona que la evidencia obtenida sea heterogénea y restringida a pacientes y litiasis que cumplan determinadas condiciones. En líneas generales, el TME puede tener cierto papel en la expulsión de litiasis de tamaño ≥ 5 mm y ≤ 10 mm localizadas en uréter distal, aunque no se ha logrado demostrar que alguno de los fármacos utilizados pueda tener especial superioridad en términos de efectividad. En gestantes y niños las indicaciones del TME tampoco estan estandarizadas. Por último, el TME en comparación con opciones de tratamiento, parece ser una alternativa más coste-efectiva y la preferida por los pacientes según estudios sobre QoL. CONCLUSIONES: Es necesario realizar ensayos clínicos de mayor calidad para poder indicar el TME con un mayor nivel de evidencia. Con la evidencia actual, parece que el TME puede favorecer la expulsión de litiasis localizadas en uréter distal y con un tamaño ≥ 5 mm y ≤ 10 mm. A pesar de ello no se han podido encontrar diferencias entre las distintas opciones farmacológicas disponibles

INTRODUCTION: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years. OBJECTIVES: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy). MATERIAL AND METHODS: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for the research (using the portal web Pubmed). RESULTS: Highest quality studies currently available show significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5 mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seems to be an alternative cost-effective compared to active options of treatment. CONCLUSIONS: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET

Medical treatment for acute renal colic. / Tratamiento médico del cólico renoureteral en su fase aguda.

INTRODUCTION: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acutephase. AIMS: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renalcolic", "treatment", "anti-inflammatory drugs", "antiemeticdrugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed. RESULTS: In the different studies reviewed, non-steroidalanti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU. CONCLUSIONS: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice.

INTRODUCCIÓN: El cólico renoureteral (CRU) es la urgencia urológica más frecuente, con un amplio espectro de gravedad que genera una alta morbilidad y elevados costes sanitarios. Sin embargo, no existe un esquema homogéneo de tratamiento farmacológico en su fase aguda. OBJETIVOS: El objetivo principal de nuestro trabajo es evaluar la efectividad y perfil de seguridad de los distintos fármacos empleados en el tratamiento del CRU y proponer un esquema práctico de tratamiento. Los objetivos secundarios son evaluar el papel de la fluidoterapia en el CRU y el tratamiento del CRU en embarazadas.MATERIAL Y MÉTODOS: Hemos realizado una búsqueda bibliográfica en PubMed utilizando los términos MeSH "renal colic", "treatment", "anti-inflammatory- drugs", "antiemetic drugs", "fluid therapy" y "pregnant". Se revisaron ensayos clínicos, metaanálisis y revisiones sistemáticas de mayor relevancia, publicados desde el 1 de enero de 2005 hasta el 15 de septiembre de 2020, escritos en lengua española, inglesa y francesa. RESULTADOS: En los diferentes estudios revisados los antiinflamatorios no esteroideos (AINES) muestran un mejor control del dolor, con menores dosis de rescate y menos efectos secundarios que el tratamiento con opioides. Sin embargo, la fluidoterapia no ha logrado demostrar una repercusión en el tratamiento del CRU. CONCLUSIONES: El tratamiento de primera elección para el CRU son los AINES, reservando los opioides para sucesivas líneas de tratamiento. El control del cortejo vegetativo se puede realizar con ondansetrón comoprimera elección.

[Medical expulsive treatment for ureteral stones.] / Tratamiento médico expulsivo de la litiasis ureteral.

INTRODUCTION: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years. OBJECTIVES: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy). MATERIAL AND METHODS: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed). RESULTS: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment. CONCLUSIONS: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.

INTRODUCCIÓN: El Tratamiento Médico Expulsivo (TME) para litiasis ureterales ha sido puesto en cuestión durante los últimos años. OBJETIVOS: El objetivo principal de nuestro trabajo es definir las indicaciones del TME, los fármacos empleados y su efectividad y proponer un esquema de seguimiento. Los objetivos secundarios son analizar la efectividad del TME en algunos subgrupos especiales de la población como son las embarazadas y los niños y valorar aspectos de coste-efectividad del TME en comparación con otras opciones de tratamiento de litiasis ureterales (ureterorrenoscopia o litotricia extracorpórea por ondas de choque). MATERIAL Y MÉTODOS: Hemos realizado una revisión de los ensayos clínicos y metaanálisis de mayor relevancia que valoran la efectividad de los diferentes fármacos disponibles para el TME. Para la búsqueda bibliográfica hemos utilizado algunos términos como medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis","effectiveness", "alpha-blockers" y "calcium-antagonists",siendo la principal base de datos consultada MEDLINE (a través del portal web PubMed). RESULTADOS: Aún los estudios de mayor calidad presentan importantes limitaciones metodológicas, lo que condiciona que la evidencia obtenida sea heterogénea y restringida a pacientes y litiasis que cumplan determinadas condiciones. En líneas generales, el TME puede tener cierto papel en la expulsión de litiasis de tamaño ≥5 mm y ≤10 mm localizadas en uréter distal, aunqueno se ha logrado demostrar que alguno de los fármacos utilizados pueda tener especial superioridad en términos de efectividad. En gestantes y niños las indicaciones delTME tampoco estan estandarizadas. Por último, el TME en comparación con opciones de tratamiento, parece ser una alternativa más coste-efectiva y la preferida por los pacientes según estudios sobre QoL. CONCLUSIONES: Es necesario realizar ensayos clínicos de mayor calidad para poder indicar el TME con unmayor nivel de evidencia. Con la evidencia actual, parece que el TME puede favorecer la expulsión de litiasis localizadas en uréter distal y con un tamaño ≥5 mm y ≤10 mm. A pesar de ello no se han podido encontrar diferencias entre las distintas opciones farmacológicas disponibles.

Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure.

PURPOSE: Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS. METHODS: A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured. RESULTS: The range of average pressures was 5.08-14.1 mmHg in the m-URS group and 6.08-20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001). CONCLUSIONS: m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.

[MicroURS. Is it a technique to stay?] / MicroURS ?una técnica para quedarse?

Micro-ureteroscopy is a novel technique derived from the need to reduce the morbidity associated with conventional ureteroscopy. Reducing morbidity, we will be able to improve quality of life of patients, for example, by shortening the times to elimination of the stones. In this article the authors intend to expose the different applications of micro ureteroscopy as well as the incipient scientific evidence on the topic.

MicroURS ¿una técnica para quedarse? / MicroURS. Is it a technique to stay?

La micro-ureteroscopia es una técnica novedosa derivada de la necesidad de reducir la morbilidad asociada a la ureteroscopia convencional. Reduciendo la morbilidad podremos mejorar la calidad de vida de los pacientes, por ejemplo, acortando los tiempos hasta la eliminación de las litiasis. En el presente artículo los autores pretenden exponer las diferentes utilidades de la micro-ureteroscopia así como la incipiente evidencia científica al respecto

Micro-ureteroscopy is a novel technique derived from the need to reduce the morbidity associated with conventional ureteroscopy. Reducing morbidity, we will be able to improve quality of life of patients, for example, by shortening the times to elimination of the stones. In this article the authors intend to expose the different applications of micro ureteroscopy as well as the incipient scientific evidence on the topic

Microureteroscopy in Children: Two First Cases.

BACKGROUND: Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children. CASE PRESENTATION: This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure. CONCLUSION: Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.

Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study.

PURPOSE: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. RESULTS: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. CONCLUSIONS: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.

[Renal allograft rupture: case report and bibliographic review]. / Estallido renal. Caso clínico y revisión de literatura.

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Estallido renal. Caso clínico y revisión de literatura / Renal allograft rupture: case report and bibliographic review

OBJETIVO: Mejorar el conocimiento acerca de las complicaciones del transplante renal y en concreto la rotura del injerto. MÉTODO: Presentación de caso clínico y revisión de la literatura. RESULTADO: Presentamos un caso de una paciente de 37 años de edad sometida a su segundo injerto renal. En el tercer día del postoperatorio, sufrió un cambio brusco en la correcta evolución, con dolor intenso en fosa iliaca izquierda (donde se había instaurado el injerto) e inestabilidad hemodinámica. Las pruebas de imagen sugieren colección retroperitoneal y adyacente al injerto. En esta situación se decide reintervención donde se objetiva la ruptura de la unidad renal practicándose transplantectomía. El estudio anatomopatológico confirma que la causa de dicha ruptura viene establecida por un rechazo agudo del injerto. CONCLUSIONES: La ruptura del injerto es una de las complicaciones más graves en un transplante renal. Ante este acontecimiento se precisa un diagnóstico rápido y tratamiento quirúrgico. El manejo conservador es la medida a tomar para la posible preservación de la unidad renal, pero existen algunas situaciones en las que la conservación es peligrosa y se debe llevar a cabo la extirpación del injerto (AU)

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out (AU)

[Urodynamic findings in patients older than 65 years: experience in the Department 19 of the health-care area of Valencia (HCAV)]. / Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 de la Agencia Valenciana de Salud (AVS).

OBJECTIVES: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. METHODS: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population) (Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people). RESULTS: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 197%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibilily of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. CONCLUSIONS: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.