Adenomectomía laparoscópica: 10 años de experiencia / Laparoscopic adenomectomy: 10 years of experience

Introducción: Los síntomas del tracto urinario inferior secundarios al aumento del volumen prostático están asociados con la edad, y se están volviendo más prevalentes por el aumento de la esperanza de vida. Presentamos nuestra experiencia con la adenomectomía laparoscópica transperitoneal para el manejo de la obstrucción infravesical de origen prostático. Materiales y métodos: Se realizó una revisión retrospectiva de los pacientes sometidos a una adenomectomía laparoscópica entre 2005 y 2015. Se registró la edad, el flujo máximo y el residuo posmiccional pre y posquirúrgicos, el tiempo quirúrgico, el sangrado operatorio, el peso y la anatomía patológica, los días de sondaje y hospitalización y las complicaciones. Resultados: Se incluyeron 80 pacientes con una edad media de 70 años. El Qmáx medio prequirúrgico fue 8,21 ml/s y el posterior 22,52 ml/s. La media del residuo posmiccional previo fue 91,4 ml y el posterior 14,2ml. El tiempo quirúrgico medio fue 137,7 minutos. Fue necesaria la conversión a cirugía abierta en un caso por lesión intestinal. El sangrado intraoperatorio medio fue 227,6 ml. La estancia hospitalaria media fueron 5,46 días, y el tiempo de sondaje 4,86 días. Tuvimos 13 complicaciones que se registraron según el sistema Clavien-Dindo, siendo 3 de gravedad. El peso medio de la pieza quirúrgica fue 80,02 g. La anatomía patológica mostró hiperplasia benigna en 75 casos y cáncer de próstata en los 5 restantes. Conclusión: La adenomectomía laparoscópica es una técnica segura, reproducible y con los mismos resultados funcionales de la cirugía abierta. Nuestra serie muestra que este abordaje es útil, seguro y con una baja tasa de complicaciones

Introduction: Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. Materials and methods: We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation. Results: We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21 mL/s and 22.52 mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4 mL and 14.2 mL, respectively. The mean surgical time was 137.7 min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6 mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02 g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. Conclusion: Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications

Laparoscopic adenomectomy: 10 years of experience. / Adenomectomía laparoscópica: 10 años de experiencia.

INTRODUCTION: Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. MATERIALS AND METHODS: We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation. RESULTS: We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21mL/s and 22.52mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4mL and 14.2mL, respectively. The mean surgical time was 137.7min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. CONCLUSION: Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications.

Corynebacterium urealyticum: aumento de la incidencia de infección y uropatía incrustante / Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy

Introducción: Corynebacterium urealyticum (CU) afecta a pacientes inmunodeprimidos, crónicos o multioperados. La uropatía incrustante (UI) representa una complicación de la infección. Objetivo del estudio: demostrar el aumento creciente de casos de infección por CU y UI en los últimos 5 años. Material y métodos: Estudio descriptivo de pacientes urológicos con urocultivo positivo a CU (enero de 2009-diciembre de 2014). Cálculo de distribución anual y características clínicas de infección por CU y UI. Seguimiento mínimo: 6 meses. Obtención de medias y rangos estadísticos de parámetros clínicos pre/postratamiento. Resultados: Total de pacientes con CU: 115 (hombres 87: mujeres 28). Edad: 67,9 años (rango 6-95). Distribución anual (casos) 2009: 9 (7,8%), 2010: 13 (11,3%), 2011: 9 (7,8%), 2012: 20 (17,4%), 2013: 31 (27%), 2014: 33 (28,7%). Incremento 2009-2014: 300%. Cirugía urológica múltiple: 89 casos (77,3%). Complicaciones quirúrgicas: 77 casos (66,9%). Pacientes con UI: 18 casos (15,6%) (hombres 13: mujeres 5): pielitis 12 (66,7%), cistopatía 3 (16,6%), prostatic capsule disease 2 (11,2%), calcificación de la malla uno (5,5%). Análisis de 18 casos con UI: PH orina pre/postantibiótico: 8 (r = 6-9) vs 6 (r = 5-7). Cultivo negativo postantibiótico: 100%. Aplicación de solución acidificante: 5 casos. Cirugía: 13 casos (72,2%). Resultados pre/postratamiento multimodal: insuficiencia renal: 12 (66,6%) vs 9 (50%), filtrado glomerular (FG): 45,8 (r = 6- > 90) vs 52,7 (r = 13- > 90). Mejoría del FG: 6,94 puntos (T Wilcoxon p = 0,102). Radiología (incrustaciones): mejoría 13 (72,2%), igual 5 (27,8%). No mortalidad específica por CU. Conclusiones: La prevalencia de infección por CU y la UI está aumentando. El tratamiento antibiótico es muy eficaz. Las soluciones acidificantes son una opción aceptable para reducir calcificaciones

Introduction: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methods: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. Results: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6- > 90) vs. 52.7 (r, 13- > 90). The improvement in GFR was 6.94 points (T Wilcoxon; P = .102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. Conclusions: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy.

INTRODUCTION: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. STUDY OBJECTIVE: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. MATERIAL AND METHODS: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. RESULTS: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6->90) vs. 52.7 (r, 13->90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. CONCLUSIONS: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Implicaciones del déficit de vitamina D en el paciente litiásico y en la población general / Implications of vitamin D deficiency in lithiasic patient and in general population

Contexto y objetivo: El déficit de vitamina D ocasiona problemas en el metabolismo fosfocálcico, pero también de salud general. El objetivo es realizar una revisión del tema, y para contextualizarlo en el paciente litiásico realizar un estudio sobre el déficit de vitamina D y su posible relación con la alteración de los valores de PTH. Adquisición de evidencias: Revisión del metabolismo, la epidemiología y la relación del déficit de vitamina D con varias enfermedades. Análisis multivariable y estudio de correlación entre los niveles de vitamina D y PTH en 100 pacientes litiásicos. Síntesis de evidencias: Se presenta una revisión sobre el metabolismo, receptores, funciones y valoración de la vitamina D, así como del tratamiento de su déficit. Se ha encontrado un déficit de vitamina D superior en el paciente litiásico que en la población general y que se relaciona significativamente con un incremento de los valores de PTH. Además hay suficiente literatura que muestra una relación del déficit de vitamina D no solo con enfermedad ósea, sino con múltiples enfermedades. Conclusión: En todo paciente litiásico debe descartarse y tratarse un posible déficit de vitamina D

Context and objective: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. Evidences acquisition: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. Evidences synthesis: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. Conclusion: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated

Implications of vitamin D deficiency in lithiasic patient and in general population.

CONTEXT AND OBJECTIVE: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.

Por qué y cómo hemos de analizar los cálculos urinarios / Why and how we must analyse urinary calculi

Contexto: Existe una heterogeneidad de criterio sobre la utilidad del análisis del cálculo urinario, así como de cuál es la metodología más adecuada. En esta revisión se presenta el análisis de la litiasis mediante la técnica del estudio morfoconstitucional basada en la combinación de la microscopía estereoscópica (MEST) con el estudio de infrarrojos (EIR). Resumen de evidencia: Existen múltiples técnicas de análisis del cálculo: análisis químico, microscopía electrónica, difracción por rayos X, MEST y EIR. Mediante la revisión de cada una de estas técnicas y el estudio de varios casos clínicos, el presente trabajo muestra la utilidad clínica del análisis del cálculo, así como las ventajas e inconvenientes de cada uno de los citados métodos. Por otro lado, se evidencia cómo el análisis mediante el estudio morfoconstitucionales el que más información clínica de utilidad ofrece al urólogo. Asimismo, se presenta la clasificación de las litiasis basadas en este método y su correlación clínica con el paciente. Conclusiones: El análisis del cálculo mediante la técnica del estudio morfoconstitucional aporta más información que el resto de técnicas y permite establecer una clasificación del cálculo de gran utilidad clínica y diagnóstica (AU)

Context: There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). Summary of the evidence: There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients is presented. Conclusions: Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility (AU)

Balanopostitis asociada al uso de cetuximab en adenocarcinoma colorrectal avanzado / Balanopostitis related to cetuximab treatment in advanced colorectal cancer patient

CASO CLÍNICO: paciente varón de 80 años, diagnosticado de adenocarcinoma de colon sigmoide + M1 hepáticas, que presenta lesiones en pene durante el tratamiento con Cetuximab, junto a otras reacciones adversas cutáneas. DISCUSIÓN: cetuximab es un anticuerpo monoclonal, cuya diana es el receptor del factor de crecimiento epidérmico. Se emplea en el tratamiento de tumores, principalmente cáncer de colon metastásico, cáncer de células escamosas de cabeza y cuello y otros. Los efectos secundarios se toleran mejor que la quimioterapia clásica, aunque presenta toxicidad en diversos tejidos epiteliales. No está descrita la lesión en el pene, y el mecanismo de afectación lo deducimos por analogía. CONCLUSIÓN: las medidas de soporte preventivas, el seguimiento y el tratamiento clásico de las balanopostitis son el pilar básico en su curación (AU)

CASE REPORT: A 80-year-old man with sigmoid colon adenocarcinoma + hepatic M1, afected by penis damage at the time of being treated with Cetuximab, beside other skin toxicities. DISCUSION: Cetuximab is a monoclonal antibody that specifically blocks epidermal growth factor receptor activity. It´s been used to treat tumours, such metastasic colorectal cancer, head and neck scamous cells cancer and others. Tolerance to it seems to be better than that to the classic chemotherapeutic agents, but has skin toxicities as side-effect. The injury over the penis skin is not yet been noticed, is for that reason that we explain the mechanism by analogy. CONCLUSION: Supportive and preventive measures, follow-up and classic treatment of balanopostitis are the key of success in the healing process of this injuries (AU)

[Why and how we must analyse urinary calculi]. / Por qué y cómo hemos de analizar los cálculos urinarios.

CONTEXT: There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). SUMMARY OF THE EVIDENCE: There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients is presented. CONCLUSIONS: Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility.

[Evolution of open versus laparoscopic/robotic surgery: 10 years of changes in urology]. / Evolución de la cirugía abierta versus laparoscópica/robótica: 10 años de cambios en Urología.

INTRODUCTION: Laparoscopic surgery has been increasingly used in urology in recent years. Laparoscopy has been performed at our center since 2001. Changes over time in the indication of open versus laparoscopic/robotic surgery, hospital stay, and learning curve are reviewed. MATERIALS AND METHODS: A retrospective review of our database from 1997 to the end of 2007. A total of 3622 procedures were performed during this time (endoscopic procedures were excluded): 67.75% open, 26.17% laparoscopic, 2.29% perineal, and 3.78% robotic surgeries. Of these, 83.79% were performed in males and 16.20% in females. Mean patient age was 58.8 years. Data from the study period, including mean hospital stay and changes over time in operating time as a function of the learning curve, were analyzed and compared to data for the last 12 months of the study period. RESULTS: The percentages of all surgical procedures performed using a laparoscopic approach in the 1997-2006 versus the last 12 study months were as follows: nephrectomy, 31.8% versus 74.7%; living donor nephrectomy, 93% versus 100%; nephroureterectomy, 28.1% vs. 93.4%; partial nephrectomy, 31.3% vs 87%; and radical prostatectomy, 17.6% versus 73.5% including laparoscopic and robotic approaches. Shorter mean hospital stays and operating times were also seen. CONCLUSIONS: Use of the laparoscopic approach has greatly increased in the 10-year period studied. In renal surgery, few indications remain for open surgery. In prostate surgery, introduction of robotic surgery in 2005 and learning of laparoscopy by several of our urologists have dramatically changed the therapeutic approach. Gradual incorporation of laparoscopic surgery has led to a decreased hospital stay and to a shortening of the learning curve.

Evolución de la cirugía abierta versus laparoscópica/robótica: 10 años de cambios en Urología / Evolution of open versus laparoscopic/robotic surgery: 10 years of changes in urology

Introducción: Durante los últimos años se ha producido un incremento en la cirugía laparoscópica en urología. Nuestra institución realiza laparoscopia de forma continuada desde 2001. Revisamos la evolución de la indicación de cirugía abierta vs. laparoscópica/robótica, la estancia hospitalaria y la curva de aprendizaje. Material y métodos: Retrospectivamente revisamos nuestra base de datos desde 1997 hasta finales del 2007. Son 3,622 cirugías (excluyendo todas las de abordaje endoscópico): 67,75% abiertas, 26,17% laparoscópicas, 2,29% perineales y 3,78% robóticas. El 83,79% en hombres y el 16,20% en mujeres. La edad media es de 58,8 años. Se analizan los datos de la década estudiada incluyendo estancia media hospitalaria y evolución del tiempo quirúrgico en función de la curva de aprendizaje y se comparan con los de los últimos doce meses de la misma. Resultados: El porcentaje de cirugías laparoscópicas respecto de las totales, realizadas en los 9 primeros años frente a las de los 12 últimos meses del estudio son: nefrectomías: 31,8 y 74,7%; nefrectomías de donante vivo: 93 y 100%; nefroureterectomías: 28,1 y 93,4%; nefrectomías parciales: 31,3 y 87%, y prostatectomías radicales: 17,6 y 73,5% sumando laparoscópicas y robóticas. Se observa disminución de la estancia media y disminución del tiempo quirúrgico. Conclusiones: En los 10 años estudiados se ha producido un gran incremento en el abordaje laparoscópico. En la cirugía renal, son escasas las indicaciones de cirugía abierta. En cirugía prostática, la introducción de la cirugía robótica así como el aprendizaje laparoscópico por varios urólogos de nuestro centro ha cambiado radicalmente el enfoque terapéutico. La incorporación de la cirugía laparoscópica ha supuesto una disminución de la estancia hospitalaria y un acortamiento de la curva de aprendizaje (AU)

Introduction: Laparoscopic surgery has been increasingly used in urology in recent years. Laparoscopy has been performed at our center since 2001. Changes over time in the indication of open versus laparoscopic/robotic surgery, hospital stay, and learning curve are reviewed. Materials and methods: A retrospective review of our database from 1997 to the end of 2007. A total of 3622 procedures were performed during this time (endoscopic procedures were excluded): 67,75% open, 26,17% laparoscopic, 2,29% perineal, and 3,78% robotic surgeries. Of these, 83,79% were performed in males and 16,20% in females. Mean patient age was 58,8 years. Data from the study period, including mean hospital stay and changes over time in operating time as a function of the learning curve, were analyzed and compared to data for the last 12 months of the study period. Results: The percentages of all surgical procedures performed using a laparoscopic approach in the 1997–2006 versus the last 12 study months were as follows: nephrectomy, 31,8% versus 74,7%; living donor nephrectomy, 93% versus 100%; nephroureterectomy, 28,1% vs. 93,4%; partial nephrectomy, 31,3% vs 87%; and radical prostatectomy, 17,6% versus 73,5% including laparoscopic and robotic approaches. Shorter mean hospital stays and operating times were also seen. Conclusions: Use of the laparoscopic approach has greatly increased in the 10-year period studied. In renal surgery, few indications remain for open surgery. In prostate surgery, introduction of robotic surgery in 2005 and learning of laparoscopy by several of our urologists have dramatically changed the therapeutic approach. Gradual incorporation of laparoscopic surgery has led to a decreased hospital stay and to a shortening of the learning curve (AU)

Revisión crítica del uso de radiación como tratamiento inicial del cáncer de próstata localizado / Critical review of use of radiation as initial treatment for localized prostate cancer

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[Adenocarcinoma in a ileal conduit after cystectomy for bladder exstrophy]. / Adenocarcinoma en conducto ileal después de cistectomía por extrofia vesical.

Exstrophy of the urinary bladder is an uncommon congenital anormaly for wich cystectomy was recommended because of a high risk of developing carcinoma. We report a patient treated by cystectomy and ileal loop diversion, who, 34 years later, developed carcinoma of the ileal loop. It is the third report of a tumor developing in a ileal conduit constructed after cystectomy for bladder exstrophy.

Fístula uretrocavernosa por fractura penena / Urethrocavernous fistula due to penile fracture

La fractura de pene con laceración de la uretra se presenta con dolor y hematoma, detumescencia, fallo en la erección y uretrorragia. Describimos el tercer caso publicado en la literatura de fistula uretrocavernosa por fractura peneana ocurrida durante el coito (AU)

Penile fracture with urethral laceration usually presents with pain and haematoma, detumescence, erectile failure and blood loss through urethral meatus. We describe the third published case of urethrocavernous fistula following blunt penile trauma sustained durind sexual intercourse (AU)

Bifidez pieloureteral proximal derecha incompleta y triplicidad pieloureteral proximal izquierda incompleta / Right proximal partial bifidus pelvis and ureter and left partial proximal pyeloureteral triplicity

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Adenocarcinoma en conducto ileal después de cistectomía por extrofia vesical / Adenocarcinoma in a ileal conduit after cystectomy for bladder exstrophy

La extrofia vesical es una patología congénita poco frecuente. Hace años se recomendó la realización decistectomía profiláctica por el riesgo de desarrollar carcinoma en la vejiga extrófica. Presentamos un caso de extrofia vesical tratado con cistectomía y conducto ileal, desarrollando 34 años después, un adenocarcinoma tipo intestinal en el asa del conducto ileal. Éste es el tercer caso de tumor descrito en un conducto ileal construido después de la cistectomía por extrofia vesical (AU)

Exstrophy of the urinary bladder is an uncommon congenital anormaly for wich cystectomy was recommended because of a high risk of developing carcinoma. We report a patient treated by cystectomy and ileal loop diversion, who, 34 years later, developed carcinoma of the ileal loop. It is the third report of a tumor developing in a ileal conduit constructed after cystectomy for bladder exstrophy (AU)

[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.

[Complex reconstructive surgery of cervico-urethral sclerosis after radical prostatectomy, due to endoscopic solution failure]. / Cirugía reconstructiva compleja de la esclerosis cervico-uretral tras prostatectomía radical, por fracaso de la solución endoscópica.

The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery.

[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.