[Complications and mortality after radical nephrectomy in a low-volume hospital.] / Complicaciones y mortalidad tras nefrectomía radical en un hospital de bajo volumen quirúrgico.

OBJECTIVES: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. METHODS: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30- day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. RESULTS: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6±41 vs 199.3±61 minutes, p <  0.01) and a shorter hospital stay (8.5±2.4 vs 5.7±3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002- 1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. CONCLUSIONS: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-volume hospitals.

OBJETIVOS: Evaluar la tasa de complicaciónes y mortalidad a 30 días después de nefrectomía radical abierta o laparoscópica utilizando el sistema de clasificación Clavien-Dindo en un hospital de bajo volumen quirúrgico.MÉTODOS: Realizamos un análisis retrospectivo de 263 pacientes a los que se les practicó nefrectomía radical laparoscópica o abierta (1996-2016). Las complicaciones postoperatorias y la mortalidad a 30 días fueron evaluadas utilizando la clasificación de Clavien-Dindo. Analizamos los factores predictores de complicaciones postoperatorias mediante análisis multivariado con regresión logística. RESULTADOS: Comparado a la nefrectomía abierta, la nefrectomía radical laparoscópica resultó en un mayor tiempo quirúrgico (112,6±41 vs 199,3±61 minutos, p < 0,01) y una menor estancia hospitalaria (8,5±2,4 vs 5,7±3 días, p <  0,001). Las complicaciones más frecuentes fueron sangrado o hematoma (4,9%) y problemas asociados a la herida (4,5%). No hubo diferencias significativas entre cirugía abierta o laparoscópica evaluando las complicaciones mediante la clasificación de Clavien-Dindo. En el análisis multivariado, un tiempo quirúrgico prolongado (Odds Ratio, 1.009; 95% intervalo de confianza, 1.002-1.015; p = 0,010) y un mayor índice de masa corporal (Odds Ratio, 0,898; 95% intervalo de confianza, 0,822-0,981; p = 0,017) fueron predictores significativos de complicaciones. CONCLUSIONES: Nuestro estudio muestra que la tasa de complicaciones y mortalidad a 30 días fueron bajas, con un mayor número de complicaciones de bajo grado y sin diferencias significativas entre cirugía abierta o laparoscópica. Un tiempo quirúrgico prolongado y mayor índice de masa corporal fueron predictores de posibles complicaciones. Aportamos evidencia adicional apoyando la realización de nefrectomía radical laparoscópica o abierta en hospitales de bajo volumen quirúrgico.

Complicaciones y mortalidad tras nefrectomía radical en un hospital de bajo volumen quirúrgico / Complications and mortality after radical nephrectomy in a low-volume hospital

Objetivos: Evaluar la tasa de complicaciónes y mortalidad a 30 días después de nefrectomía radical abierta o laparoscópica utilizando el sistema de clasificación Clavien-Dindo en un hospital de bajo volumen quirúrgico. Métodos: Realizamos un análisis retrospectivo de 263 pacientes a los que se les practicó nefrectomía radical laparoscópica o abierta (1996-2016). Las complicaciones postoperatorias y la mortalidad a 30 días fueron evaluadas utilizando la clasificación de Clavien-Dindo. Analizamos los factores predictores de complicaciones postoperatorias mediante análisis multivariado con regresión logística. Resultados: Comparado a la nefrectomía abierta, la nefrectomía radical laparoscópica resultó en un mayor tiempo quirúrgico (112,6 ± 41 vs 199,3 ± 61 minutos, p < 0,01) y una menor estancia hospitalaria (8,5 ± 2,4 vs 5,7 ± 3 días, p < 0,001). Las complicaciones más frecuentes fueron sangrado o hematoma (4,9%) y problemas asociados a la herida (4,5%). No hubo diferencias significativas entre cirugía abierta o laparoscópica evaluando las complicaciones mediante la clasificación de Clavien-Dindo. En el análisis multivariado, un tiempo quirúrgico prolongado (Odds Ratio, 1.009; 95% intervalo de confianza, 1.002-1.015; p = 0,010) y un mayor índice de masa corporal (Odds Ratio, 0,898; 95% intervalo de confianza, 0,822-0,981; p = 0,017) fueron predictores significativos de complicaciones. Conclusiones: Nuestro estudio muestra que la tasa de complicaciones y mortalidad a 30 días fueron bajas, con un mayor número de complicaciones de bajo grado y sin diferencias significativas entre cirugía abierta o laparoscópica. Un tiempo quirúrgico prolongado y mayor índice de masa corporal fueron predictores de posibles complicaciones. Aportamos evidencia adicional apoyando la realización de nefrectomía radical laparoscópica o abierta en hospitales de bajo volumen quirúrgico

Objectives: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. Methods: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30-day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. Results: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6 ± 41 vs 199.3 ± 61 minutes, p < 0.01) and a shorter hospital stay (8.5 ± 2.4 vs 5.7 ± 3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002-1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. Conclusions: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-Volume hospitals

Assessment of the urodynamic diagnosis in patients with urinary incontinence associated with normal pressure hydrocephalus.

AIMS: To assess the urodynamic patterns present in patients with adult normal pressure hydrocephalus (NPH) in our institution. METHODS: Retrospectively conducted study on patients diagnosed with NPH by the Neurosurgery Department of our institution, without etiological treatment or urogynecological disorders, who underwent an urodynamic study (UDS) performed according to methods proposed by the International Society of Continence (ICS). Clinical information, complementary tests and UDS were collected, and descriptive analysis was performed, with special focus in urodynamic final diagnosis. RESULTS: Eighty-one UDS performed between 2003 and 2013. Fifty-one Males (63%). Mean age: 74.89 ± 8.58 years old (range 52-88 years). Classical triad of symptoms: gait disturbance, dementia, and urinary incontinence (UI) presented in 48.1%. Urinary urgency in 80.9% and UI in 70%. In two cases (2.5%) UDS was not valuable. Urodynamic features of the 79 remaining studies revealed overactive detrusor (OD) in 56 patients (70.9%), being associated with Stress UI (SUI) in one case and with bladder outlet obstruction (BOO) in 19. SUI in six patients (7.6%) and BOO in five (6.3%). Detrusor underactivity in four cases (5%) and normal study in eight (10.1%). About 47.1% of males presented BOO. Cerebrospinal fluid shunt surgery was performed on 32 patients during follow-up, with subsequent clinical improvement in 90.6% of them. CONCLUSIONS: OD was the most frequent diagnosis within UDS conducted on adult NPH patients in our institution, with BOO in an elevated percentage of them. Etiological treatment led to symptomatic improvement in most of patients.

Carcinoma urotelial de pelvis renal en riñón ectópico presacro / Transitional Cell Carcinoma of the Renal Pelvis on Presacral Ectopic Kidney

No disponible

Microvejiga tras BCG / Microbladder after the BCG therapy

No disponible

Testicular reconstruction after testicular rupture and review of the literature.

OBJECTIVE: To report a clinical case of testicular rupture and review of the literature published. METHOD: A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound. RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up. CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.

Reparación tras rotura testicular y revisión de la literatura / Testicular reconstruction after testicular rupture and review of the literature

OBJETIVO: Describir nuestro caso clínico de rotura testicular y revisión de la literatura. MÉTODO: Varón de 15 años que sufre rotura testicular tras accidente deportivo que fue diagnosticada por ecografía doppler. RESULTADOS: Se realiza exploración quirúrgica y se repara la fractura. Buena evolución postoperatoria. Conservación del 75 % del tamaño testicular. CONCLUSIONES: La rotura testicular es una entidad infrecuente pero importante por las secuelas que puede producir. Es fundamental un diagnóstico y tratamiento precoz para evitar la orquiectomía (AU)

OBJECTIVE: To report a clinical case of testicular rupture and review of the published literature. METHODS: A 15 year old male with a testicular rupture after a sport injury was diagnosed by Doppler ultrasound. RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up. CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and management to avoid orchiectomy (AU)

[Mondor's disease vs. sclerosing lymphangitis of the penis]. / Enfermedad de Mondor versus linfangitis esclerosante de pene.

OBJECTIVE: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. METHOD: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. RESULTS: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. CONCLUSIONS: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

Enfermedad de Mondor versus linfangitis esclerosante de pene / Mondor´s disease vs. sclerosing lymphangitis of the penis

Objetivo: Resaltar la diferencia entre Enfermedad de Mondor y Linfangitis Esclerosante del Pene mediante el análisis de tres casos clínicos y la revisión de la literatura existente. Métodos: Describimos dos casos clínicos compatibles con el diagnóstico de enfermedad de Mondor y otro compatible con Linfangitis. Resultado: La buena y muchas veces espontánea resolución de estas dos patologías dificulta el diagnóstico y seguimiento de estos pacientes. Conclusiones: La abstinencia sexual es una de las medidas más efectiva para la pronta resolución de ambos procesos. Para el diagnóstico diferencial entre ambas entidades es de gran utilidad el eco-doppler peneano. El tratamiento farmacológico principal se basa en antiinflamatorios (AU)

Objective: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. Method: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. Results: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. Conclusions: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence (AU)

[Testicular seminoma in a patient with Kartagener's syndrome]. / Seminoma en paciente con Síndrome de Kartagener.

OBJECTIVE: To present the association between Seminoma and Kartagener's Syndrome (KS), and its relation with infertility. METHODS: We report one case of Seminoma in a patient with Kartagener's Syndrome, focussing on the possible relation between both pathologies and fertility. Bibliographic references are discussed. RESULTS: Orchyectomy was performed on a patient with Kartagener's Syndrome and testicular tumour. The pathology result was Seminoma. Azoospermia was obtained twice in the post operative espermiogram, not being easy to establish the implication of each pathology (KS or Seminoma) in infertility. CONCLUSIONS: A patient with KS and Seminoma plus azoospermia is reported, with a great outcome from the oncological point of view. Bibliographic references are described. The association between KS and Seminoma is exceptional in the literature.